The Checkup with Doctor Mike - The Truth About BetterHelp, Life Coaches, & Positive Affirmations | Dr. Ali Mattu

Episode Date: September 12, 2023

Rebooting psychotherapy: https://pubmed.ncbi.nlm.nih.gov/26162113/ Mental health for all by involving all: https://youtu.be/yzm4gpAKrBk?si=cTioab_Bzcj9YzL7 81 words episode of This American Life: https://www.thisamericanlife.org/204/81-words BetterHelp: https://www.thecut.com/article/mental-health-therapy-apps.html Kaiser mental health strike: https://www.kqed.org/news/11929713/kaiser-mental-health-workers-appove-new-contract-ending-10-week-strike Myers Briggs: https://youtu.be/Q5pggDCnt5M?si=z0vxswUuD-Enc9ga Follow Dr. Ali Mattu, clinical psychologist from Columbia University and YouTuber, here: YouTube: https://www.youtube.com/channel/UClIZqOLqUCro7bKztUjYCNA Instagram: https://www.instagram.com/alimattu/ Twitter: https://twitter.com/AliMattu 00:00 Intro 01:09 Social Media Doctors 07:16 When To Start Talking About Therapy 11:30 Triggering Language 22:57 Medical Turf Wars 49:00 Thought's Don't Matter 56:19 Life Coaches / School Curriculums 1:14:24 Affirmations / Manifestations / Ice Baths 1:26:20 Punishment 1:38:00 BetterHelp 1:58:14 Hacks / Meyers-Briggs / Astrology 2:10:35 The Quesadilla Story 2:25:35 Doctors As President / Pokemon Go 2:33:44 Perks Of Being A Psychologist Host and Executive Producer: Doctor Mike Produced by Dan Owens and Sam Bowers Art by Caroline Weigum

I was interning here at Bellevue Hospital, and I did a rotation where I was just working with forensic patients, people in the correctional system. Whenever I looked at the patient's chart and looked at the experiences they've gone through, it's like trauma, poverty, neglect, like all these layers of things that we do know lead to very difficult problems. Do you believe it absolves people of their? wrongdoing. I'm super excited to introduce to you the next checkup podcast guest, Dr. Ali Matu, clinical psychologist from Columbia University, who has also an immensely popular YouTube channel where he talks all things mental health, doing a lot of the same debugging that we do on our YouTube channel.

We're going to get into some really interesting topics from the better help controversies to whether or not life coaches are the same as psychologists. Huge thanks to Dr. Alima, too, for being so open, sharing many things personal and professional. Let's get started with the checkup. Let's solve mental health. That would be, imagine after this conversation, we're like, hey, did we just solve mental health? I think we did. Wow.

Yeah, that would be powerful. That would be cool. That would have a headline on the Daily Mail. Doctors sit in podcast, solve mental health. These days, though, when I look at social health. some doctors and medical professionals and mental health specialists talk on social media like they do podcasts or they clip things. They act like they're solving things. Yeah. Yeah. I see that happen a lot these days. Totally. What's your take on medical professionals and media as it

exists today? Because I think if we looked 10 years ago and we saw the Dr. Oz's of the world, there was a different take. What's it like for you now on social media? There's so much diversity. I mean, you've got short form content, you've got people in grad school, in medical school, people in undergrad, people who don't even have

any expertise putting out health care information, and then you have all the way to what used to be the only thing I saw, which were like lectures put online by like experts. Then you got everything in the middle, stuff that you do, stuff that I do.

So I think it is, It's a bit of a wild west world of health care information. And the thing I worry about is how hard it is for the average person to figure out what is effective, what is evidence-based, what's digestible. There was a recent review of ADHD TikToks, and like most of the stuff, like the vast majority of TikToks were false, inaccurate. And it's tricky to make something engaging, fun, viral, and make it really accurate. And so I think that's the problem. We have so much stuff, but it's really hard to know what's good. Yeah, on the ADHD front, I'm curious because I feel like a lot of the content when it's

made surrounding ADHD or really any mental health topic, it's patients sharing their experiences, sharing their stories, maybe. their own advices of what's worked for them. And then it leads to people taking their advice. It leads to people self-labeling or self-diagnosing themselves. Have you seen that as a pattern evolve? And do you think they're dangerous to that? Oh, absolutely. It's both good and bad, as we say in dialectical behavior therapy. It's a dialectic. Both are true. There's so much value in people sharing their stories. It helps people to feel less alone. It helps people to understand their own problems and realize they're not the only one. It also can can give people hope.

But what does really, or I should say, and what really frustrates me, all that stuff is good. And at the same time, if it becomes prescriptive, this is what worked for me and this will work for you, that's a problem. That's actually why I started making YouTube videos. I was working with a patient who was this adolescent young woman struggling with depression, struggling with motivation, I think struggling with hair pulling disorder, trichotillomania. And she found this video and she's like, Dr. Ali, I want to show you this. It's like really helped me. And she fired it up. It was like this three minute personal story, super motivating and full of terrible advice. Like the opposite. Like disproven advice. Yeah. Yeah. Which.

you know, I couldn't even remember what it actually was. I just remember being like horrified by it because it was the opposite of everything you were working on. But it was presented in a way that super resonated with her. Like, eye contact right in the camera talking to the audience, storytelling, very YouTubey, and it worked. It really made her feel less alone, gave her hope, but it was also

prescriptive in a way that wasn't helpful. I feel like this prescriptive aspect that you're looking for in the delineation of what's problematic and what's not isn't always clear to me. And in the people who make this content, they're very smart in many ways to not be prescriptive so that they don't cross that line. But what they do take advantage of is the psychology of influence, where they know that even if they say this is not meant to be for you, but it worked for. me, that line can sell a lot of product. It can create a lot of engagement. So even if they're not being prescriptive, if they're describing their journey, like the best example of this that I covered on my channel where Gwyneth Paltrow had COVID and she talked about her COVID treatment protocol. And most of the things were things you could buy on her website, obviously. And she said

very clearly, this is not recommendation for everyone. But it worked very well for me. I mean, It covers legal risk right there and yet is problematic. Yeah, absolutely. What I also worry about is the mental health impact of telling your story. So something I always recommend people is we tell stories about our scars and not our wounds. So stuff that's really raw, stuff that you recently went through, stuff that makes it difficult for you to sit with your emotions for the rest of the day. That's probably a wound. you're probably not ready to talk about that publicly.

You want to wait until you are able to sit with this stuff. It doesn't activate you. It doesn't trigger you. You've got some perspective and context with it, right? So if people are sharing their stories to something that's really raw, you're opening yourself up to potentially going viral, all the comments coming in, all the criticisms, all the backlash, stuff that you and I are very familiar with, right?

No matter what you say, people are going to react to it. And sometimes that can be really detrimental to people's mental health. How would one know if there would be ready to make the step to speak about it publicly? I think you should always start with a real-life scenario, real-life people in person and try sharing your story there. Is it something that you are able to go through and still feel like you can live your life? Like you can get through the day. you're not struggling with nightmares now for the rest of the week, stuff like that.

So start small, start with a small group of people and then expand from there. So it's almost like an escalation exposure therapy. Yeah. Where you're visualizing first, then you're experiencing on a small scale, then you're continuing to grow. Yeah, yeah.

And I mean, that's how we treat trauma as well. The thing, though, with both trauma and this, is you might not know until you try. So I've shared difficult stories publicly and it's normal to have some reminders of that stuff. It might come up in your dreams. It might you might not feel that great for a little bit. That's okay. If you can tolerate that, go for it.

But you kind of sometimes need to try. And so make that trial as less of a risk as you can and then go from there. I mean, sharing publicly on YouTube, on TikTok, on Instagram is so much. more of a higher risk than talking to like two of your friends or talking to like your family about something. I feel like that risk comes from less so that people will bring it up to you and it'll be brought into your life more often, but more so that people don't know who you truly are. So ways that you acted, ways that you behaved, maybe perceived differently.

And totally that's okay for the person making that read because you're putting it out there for them and they don't know better so they're trying their best to make a read on a situation and if it's inaccurate that can make you feel terrible totally this is this kind of intersects with adolescents and like developing brains and all that stuff so what I grew up at a time when you could totally do crazy stuff and I shouldn't say crazy stuff I'm a psychologist what am I doing I always I I just talk to my patients, we don't use that word. The words loaded with all the stuff. I grew up at a time where you could really experiment.

You could make big mistakes, and they wouldn't follow you forever. And what I worry about now is how that impacts, doing all that stuff, making mistakes. You know, your frontal lobes not fully developed as a teenager. You've got an accelerator, but the break doesn't really work well. So you react to things more quickly. You're more emotional. It's harder to think about the consequences. All that stuff is normal.

And you might not have been raised in a situation that was nurturing or educational where you would know how to know better. Totally. And people who've gone through traumas early on, it like revs up your emotional or revs up your nervous system. You react more quickly. and it takes longer for your body to calm down. All that stuff can happen.

But now if it's happening online, it might follow you. And so even if you delete that Instagram reel, even if that TikTok is gone, it might live on in some way. So, you know, all that stuff kind of, yeah, worries me. You know what worries me from more of a confused standpoint because I don't know how to handle it? You just kind of lived this situation

where you said the word crazy in talking about circumstances, not an individual, not a person. And yet you feel uncomfortable saying it. Yes. I feel like there's in many ways a situation where we start stepping outside of the norm and start coming into the extremes.

Whereas one might say, you could say any word you want, it doesn't matter, sticks in stone, so break my bones, all that mentality, toughen up, all that. Then you can go into the place where if you say words are incredibly triggering to me,

where do you fall on this spectrum, like saying the word crazy? Yeah. If you're not talking about someone else. Like is this a problematic thing? Should be policing our words? I think we should be way more humble in allowing people to make mistakes. People like you and me who have platforms, like we are going to make mistakes. And I think there's a lot of value in us learning from those mistakes publicly as well.

and what's what is a problem is if we get to a culture where people are afraid to speak up on different things because they're so fearful of being canceled

that I'm not even going to touch these topics Dr. Mike this happened to me with YouTube so for a long time I was not making content related to suicidality suicidal thoughts

all that kind of stuff because it seemed like anytime I did that that video was buried. It was gone. Which is true. Which is true. That wasn't in your mind.

No. Yeah. Yeah. I was sending angry tweets to Twitter. You know, or angry tweet. Tweets are gone. It's not even the things like X. You were sending angry X's.

Angry X's. Although that has a different. No, right. Right. That could get me canceled. I was sending messages on the platform formally known as Twitter about this. Now, so here's what was going. is I would make these videos and they would get buried and that was by design, which I now know from talking to people at YouTube because they didn't know how to handle videos that might talk about suicide in a helpful way in terms of what to do about this from suicide professionals, from experts, versus videos that might be harmful and might make people more at risk for hurting themselves or killing themselves.

YouTube didn't know how to handle that. Now there's a lot more stuff built in to identify who's an authority figure, who can talk about these things because these things need to be talked about because people are going to YouTube to learn about this stuff, right? So I just, I didn't make content that came anywhere near that because this is something I want to do. I want to grow my channel. I want to do all that sort of stuff.

So why am I going to make content that's going to get buried? So in that way, I felt like I was, this is a, very small, like, YouTuber privileged example of this. But yeah, I absolutely didn't talk about certain things because I was afraid that that conversation would get buried in some way. And what was the problem with that? What was a problem with that? Yeah. Like, then... Were people upset about it? Is that why you brought it up? Well, sometimes people would ask me, like, why don't you, you know, you talk about depression and you talk about this stuff. Why don't you talk about suicide? Oh, I see. When you're saying the word, when I said, like, you said the word crazy,

but you wouldn't speak about suicide. Yeah. But that was a very kind of business-centric mindset. Yeah. I'm saying it more from, like, if I, like, what's a good example of this? When I refer to a patient who has diabetes, I try to avoid using the term diabetic. Because it, like, brings them to, they're just a person who has diabetes only. That's who they are.

And they're not. But at the same time, like they say, you would never say that person's a hypertensive. And yes, I wouldn't, and I wouldn't say they're a pulmonic, but I could say that they're asthmatic. Yeah. So are we putting too much emphasis on this where we're actually validating the insecurities people have around these words by being so careful, where we're being too prudent and actually causing more harm? It speaks to the identity issue. Like some people might identify as being diabetic. In my world, some people might be. identify as being bipolar. And that can be both helpful that you find this community. I'm not the

only one. You know, oh, you're bipolar too. Not bipolar too, like two, but bipolar as well. Little mental health joke. But that could be both. Yeah, you could be both. But you might feel less alone and at the same time, it can be problematic if that identity is now limiting you. So I see this a lot with social anxiety. If someone identifies as being socially anxious, then you might make decisions like, oh, well, this is just what a social anxious person does, as opposed to this is a mental health condition I have, and I can learn to manage it. I can overcome it in some ways. I can come to terms with it in other ways. But there's more to my identity than just this. It's, yeah, I've come, I've struggled with this issue myself, and I've come to it.

a place of, it's probably best to keep our identities small and pretty specific. I think that helps us to be most flexible with all of the stuff. You're thinking about it. Yeah. I don't, I'm trying to follow. Yeah, it's, so you might have an identity as I'm, I'm, I'm a man. I am a Pakistani American son of immigrants. I'm a Democrat. I'm a Muslim. I am, you know, I'm a California and I'm blah, blah, blah. I can go through this whole list, right? And then when any one of those identities is challenged, I'm a psychologist. A psychologist is a good example. So let's go with that. Like, I am a clinical psychologist. If that identity is challenged in some way, it's going to activate all the stuff. It's going to make me feel very defensive. So this

happened in 2016. Jeb Bush, when he was running for Britain, this seems so not significant, given our politics now. But Jeb Bush said in one like press statement somewhere that psychology majors are the most popular majors in America and this is a problem. They're just become fast food. They're just working fast food. If you major in psychology, you're not going anywhere. We need more business majors, blah, blah, blah. My identity was threat. as a psychology major, so I made a video about it. It took off. I made this hashtag this psych major. That took off. People started dressing up as this psych major for Halloween and all this all this weird stuff happened, right? But in doing so, I also sort of insulted people who work

in fast food, and I was also sort of dismissive of a wide variety of people, and I sort of glossed over real problems with the psychology major. Yeah, it's the most popular major, but oftentimes people don't get good career advice about what you can and can't do as a psychology major. So anyways, this is all to say that if you do hold a lot of these aspects of your identity really close to your heart, and then in some ways they're threatened,

it activates your anger. Anger is a massively motivating emotion. it definitely makes sense if there's an injustice happening if your goal's being blocked but did I really need to make that reaction video to Jeb Bush did I really need to say all these things

because then I made this like apology video talking about like what I've learned from this and I wish I had more of a nuanced reaction to it but nuance doesn't really work well on the internet as we've all learned so I try to keep my identity very small now to minimize the amount of times emotional reasoning getting in the way

yeah yeah so I can take a little bit more of a wise mind approach I mean that's very smart from an individual perspective in how you manage your own emotions for me as a content creator and I'm sure for you as well when I make a video about the good doctor and I mention that

the main doctor and it has autism like in my first episode I may have said he's autistic and in the next ones I said he's a person with autism I've gotten arguments on both sides of that equation where it's like, why are you taking away his identity or why are you labeling him his identity? And I don't know what the correct way to go. And I've even polled people about this to try and figure out the best way.

Yeah, yeah. What did the poll say? This is mixed. Yeah. And it's like depends which, you know, biased population you're asking. Yeah, it's a really good example about all of this sort of stuff because we, We used to have separate diagnoses for Asperger's, for autism. There's one more that I'm blanking on that I'm sure someone will mention in the comments.

And then around like 10 years ago, when the new version of the DSM, the diagnostic and statistical manual of mental illness, when version 5 came out, they collapsed all the diagnoses to autism spectrum. Yeah. And the reason for that is because these. separate diagnoses, all shared major features in common, the main features of autism, which is more of a logic bias over social, more spatial oriented, like thinking much more concretely and specifically. And all of these different diagnoses, they had these problem areas. The only difference

really in the research seemed to be the level of severity and the level of impairment. So it was truly a spectrum where you could be you could be over here and have autism or you could be over here and have autism but the main problems are the similar or are the similar that's not how humans talk the the main problems are similar it's just the the way it's impacting your life well the reaction was quite not so good to that from who from experts or patients no from the community of people, from parents of what would have been said like the autistic or the or Asperger's community. And now we would say family members and people who are on the autism spectrum because that was so much a part of identity. And it became a lot of people liked identifying

as having Asperger's because there was, you knew what that meant. But now they suddenly became someone who's on the autism spectrum. Vague. Yes. And that wasn't very as clear what that means. So it watered down their identity to some degree. It watered down the identity. It might have been more stigmatic. Like this is more of a impairing problem.

It yeah, it speaks to all these problems that we're just talking about. The identity can bring a community together, but it can also limit in a lot of ways and it can also activate biased beliefs as well about, about all these problems. But this, I mean, I wanted to ask you about DO stuff. Because I run it, one of the things I hate the most in mental health are all the

turf wars. Sure. Right. We've got psychologists, social workers, marriage and family therapists, psychiatrists, et cetera, et cetera. So these identity wars are triggered in health care all the time. I'm assuming you've run into this yourself. To some degree, I think it happened more probably to the generation before me of DOS, just because now we train together in residency. Like I trained in an MDDO residency, so no one knew who was what, unless you had DO hours where we specifically block off hours for hands-only treatment. But otherwise, it was minimal.

I think there's still some exists, and I've seen like even comedians poke fun at it. Hauss and Minaj. Yeah, exactly. I, I don't know, I, I view that more as a bureaucratic problem, more than it is a real life problem. Yes, that's good to hear. On a practical level, I have never seen a play out where a patient comes into the emergency room with a life-threatening issue asking what degree someone has. Yeah. And until that happens, I'm not overly concerned.

So I don't see the same thing in mental health. You see it more often like what? Oh, yeah. Yeah. And I think it speaks to. all of the lack of transparency we have and how mental health works, mental health care, how it works. Well, do you have a personal take on the fact

that there are so many specialties that offer therapy? And even therapy is the scientific word for it, I guess, or the medical community word for it. But now there's life coaches, self-help gurus that are promising things. And I'm curious how you navigate that field From a recommendation standpoint. That's going to require a sip of water. Okay.

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So I'll say first, let me anger all of my colleagues that are watching this. I think that's a good place to start. Okay. So let me offend all the psychologists that are watching this. So I'm trained as a clinical psychologist. Specifically, I'm an anxiety guy. I'm a child and adolescent trained anxiety guy because I wanted to work with the whole life spectrum. And then so that meant if I can work with kids, I can work with anyone, right?

What I, what a lot of my, what was implicit in a lot of my training is psychologists are the highest trained mental health. professionals. We spend years and years and years in grad school specializing in these different problem areas. We both do, if you have a PhD, you probably are doing some research as well, or if you have a Sidi, which is one of the other degrees, one of the other pathways, then you have even more clinical experience with patients than most psychologists have. Anyways, I was sort of implicitly trained that we're the best and that's not what I've found by any means and as a as a practicing psychologist who has worked in a lot of interdisciplinary environments it's not what I've seen at all what have you seen I've seen a lot of people who offer really bad psychotherapy

don't really have expertise and anxiety but as psychologists oh as psychologists yeah yeah who are, you know, they've had training in different things, and they might take on patients who have obsessive compulsive disorder, which has a very specific evidence-based treatment, exposure response prevention. It's one of the best treatments who've got. And they aren't. Well, it's like CBT plus E-A-R-T, right?

Yes, yeah. So it's, and we could even dive in more into that. But it's a very specialized treatment. And I have worked with people who just do not, colleagues who do not know how to do that, but they're taking on these cases. I think that's a big problem. At the same time, I worked with social workers

who had less formal training than me, but they're fantastic psychotherapists. They know what they're doing, they're sticking to their things. This is not to say like social workers a veteran psychologist, but this is to say one of the biggest problems in mental health is you can get your license and you can see anyone. I might not have any training with schizophrenia, with eating disorders, with whatever, but I can see all those people. Just look on psychology today

is one of the most popular, yeah, therapist finding tools. And one of the big red flags I always have is someone who lists like expertise, family therapy, marriage therapy, OCD, anxiety, eating disorders, depression, bipolar depression, ticks, Tourette's. Like, if the list goes on and on and on, that's not possible. So there's no family medicine doctor of? You do have therapists who, especially those who work in rural areas, who have to see anyone who comes in, just because they may. might be the only therapist. And you get this a lot in psychiatry. We have a massive shortage of

psychiatrists. We can get into the differences between psychologists, psychiatrists, social workers, but in general psychiatrists have primarily a lot of expertise in medical management, pharmacotherapy, in treating these problems with medicine, and in some cases with surgeries and all of that sort of stuff, right? There's a massive shortage of them in the country. So if you're a psychiatrist or a psychotherapist working in a rural area, you will see whoever comes into your door. But that's true of a rural practicing family medicine person as well. Yeah.

There are therapists who work in integrated primary care settings, who would work with someone like you, who would do a lot of the initial work. Like, let's say you see someone, and I know you do this because I've seen your stuff. But you talk about mental health, you talk about sleep, you talk about stress, you talk about those kind of things in the 10, 15 minutes you have with your patients, right. And in the best case scenario, if someone has sleep problems and you've sort of ruled out

any medical reasons for it, you'd walk that person over to the psychotherapist down the hall and they would do an initial sleep consultation, maybe give the person a few different things to do and have them come back in a week. then if they need more help, then refer them to a sleep expert. That's the ideal world. But what happens often is people in mental health take whoever comes their way and they might not have the expertise. I'm not saying most people do this, but it happens a lot. So I have two follow-up questions from all that. Number one is your examples of psychologists maybe not giving the best care of outside of their scope, and on the flip side of that, maybe a social worker giving better care

than a psychologist would. Are you using unique examples, outliers, as the rules to make that statement? Two things. So first, the problem is in your question, you said outside their scope. It's not outside their scope. So scope of practice is a big thing we talk about in health care, right? What are you licensed to do. Scope of practice for mental health is really broad. So you get a license as a psychologist, as a social worker masters and family therapy, all that sort of stuff. Your scope of practice is like mental illness, which is really broad.

So if I am a psychologist who's working with someone who has an eating disorder, I've never seen an eating disorder case. It's not necessarily out of my scope of practice. It is probably out of the ethics, ethical code. You're supposed to practice within the bounds of your competence. So it might be out of my competence. Okay. Yeah.

So that's... So let me rephrase it. Yeah, I'm getting into the weeds there. No, that's a good point. Okay, so if you have psychologists treating outside of their competency, but then you have social workers. who are doing a better job at treating within their level of competency,

are those examples of situations that are outliers where usually it still is what you were taught that psychologist would be the upper echelon, or is it not that? That's a good question. So a lot of my colleagues who are watching this will probably say, I've never experienced that in my life.

And a lot who are watching will probably say, yes, this happens all the time. It happened to me a lot in New York when I was practicing out here because I was an anxiety expert at an anxiety clinic and we were more tertiary care, which means people have gone through a few different forms of treatment and it hasn't worked and it's escalated or they've gotten the wrong treatment and they eventually bubble up to this anxiety specialty clinic. So I worked with a lot of people who did get bad care or the wrong care, and now they're coming to someone who actually knew what to do with this. Sure. But I do have a very outlying experience there that's specific to New York City, specific to anxiety. Yeah. My second question that I was going to mention is my education, my education.

education from the behavioral side has always taught me that it's not the degree, it's not the sub-specialty, like whether you've been formally educated on eating disorders or OCD or what have you, but it's the connection you make with your mental health specialist. And part of what a first vision it should entail should be you checking the chemistry, if you will, between you and your therapist or a doctor or whoever is doing it. So basically the difference between a heart Harvard-educated psychologist, a community-educated family medicine doctor, a social worker or health coach, the success will come from the chemistry. Do you believe in that thought process?

Yes, and it's also about their experience with the problem you've had and the training and the problem they've had. And this gets to the whole problem is if I see a physician, there is, if I see a physician, there is an assumption that they have expertise in my problem and if they don't they're going to refer me to someone who does that's been my experience in health care my favorite my two favorite people two favorite types of physicians are pediatricians because they take care of my kids and they're amazing and they give me way more time than I probably should get I do not know how pediatricians do this They're amazing people and family medicine because we develop a relationship that lasts over years.

And I love seeing my physician who I've been seeing for a long time. It's fantastic, right? But what my experience in both situations has been, when they need to refer me out, they do. And if they don't, they know exactly. what to do to treat this problem. This happened with my daughter. We were correcting a vision problem she had, and we were referred to a child ophthalmologist, yes?

Yes. Yeah, I want to make sure. And so, and that's how it worked. This was a specialist. She's going to help you with this problem. When you go to mental health, you also make that same assumption that this therapist has expertise

with the problem I have and if they don't they're going to refer me to someone who does but that doesn't really happen sometimes it does sometimes it doesn't and I think that's a huge problem

I think there should be yes you should look for a relationship yes you should look for a chemistry yes you should look for chemistry match but what I always advise people is to ask the person how much experience do you have with this problem

how do you treat it how do we know if we're making progress how is progress going to be measured how is this treatment going to end and Dr. Mike this gets to a big problem which is how do people even know what problem they have this is implying

such a high level of knowledge and motivation and most people don't have that and that's why I make the content I do all I see myself is sort of as a guide that helps people open doors and ask the right questions

I don't hold any belief that most of my content in itself is helping people with their problems I see it as a way of educating people on their next step so that they're an informed informed person. And this is also making a big assumption

that people are seeking treatment, have access to treatment, that providers don't have this massive wait list, that people are overcoming all the stigma of mental health, that they can afford it, all that stuff. The way that I think about, this is probably the one of the very few and rare areas that you and I may disagree slightly.

Yeah, give it to me. Because being a generalist and seeing the world move into a very sub-specialized place, I see that play out for both good and bad. For good, for very specific situations where you need specialized help, like the ophthalmologist is perfect. Like if it's going to be outside of a basic corneal embrasion,

conjunctivitis, stye, preceptile cellulitis, something like that, I'm getting the ophthalmologist involved. I may start some initial form of treatment to keep the problem from ballooning out of control, but ultimately it's going to be the ophthalmologist or the eye surgeon. I'm not going to be doing colonoscopies.

I'm sending them to the gastroenterologist. But it's also created this world where even some of my friends who are nurses fail to believe that there are doctors out there, primary care doctors, that can treat things like hypertension. They say things like, well, once a patient is started on the first medicine, they should find a cardiologist. And I get confused because I've worked extensively in my training with cardiologists. I see what they've done.

and there's no difference, like we're reading the same research. We're following the same guidelines when it comes to what medications to start, what to look out for. And in fact, what I found is being less specialized gives me a better look at the person from what other specialists are they seeing, what other medical problems are going on versus I see one organ system and I treat that one organ system. And I know mental health does not play out in that same way.

But the reason I bring this up, and as my concern of encouraging people to seek sub-specialty in mental health, is it's already impossible to get my patients sick. So I'm thinking from my own experiences, I oftentimes, not being formally trained in CBT, do some watered down primary care version of CBT to help my patients find a little interest in the subject, as almost like a spark learner. And I explain to them, this is not, I'm not becoming your therapist. I have to be very clear about that because some of them want to come back regularly, but I explain my availability issues, my training, so that they're very well informed.

But if I was to tell them, like, I can't talk to you about this issue because I'm not formally trained in it, and I have to find you a subspecialist in this specific condition and no one else, knowing their decreased motivation levels given their condition, knowing the barrier to access, the financial issues, their trauma history, I probably won't find a doctor for anybody. So we actually agree. Okay. Because I agree with everything.

So this is why I both love this topic and I'm so deeply frustrated by it. I mean, this is going to be a problem that I will go to my grave, like, ruminating about this problem. So a lot of people might not need. full-fledged therapy from an expert and you're absolutely right it is impossible to find you don't want to know my wait list you know the the most depressing thing I hear the most depressing question I get is Haley can you help me find a therapist because I know

this is going to be a challenge every colleague I know is like booked full beyond capacity near total burnout. And it's, it's really hard to get people in. So absolutely with you on that. Any help might be better than no help in the world of mental health. And sometimes. Sometimes. If done responsibly. Yeah. Where I think, and the other thing that's that's really important here in this conversation is 50% of all mental health problems present at primary care in family medicine in environments that are not labeled mental health. And so I believe mental health doesn't belong to mental health experts. I think it belongs to everyone. And we need a family of approaches to address the problems that we're seeing. A lot of people will benefit from a mental

health visit with someone they trust that might help them understand their problem, give them a few ways of coping with it, build up their motivation. And in fact, I have colleagues who are working on single session interventions that just do this. Build motivation, give education, and give some coping skills. Probably a lot of similar stuff that... Yeah, yeah. Yeah.

Like some basic crisis planning, moving from pre-contemplation. to contemplation, like something, so that we're moving in the right direction. And I'm lucky in that exactly what you pointed out, that 50% of my visits are mental health related. They're coming in with their guard down. Yes. They trust you.

Well, maybe. But more so, their guard down, when you're going in to see a mental health specialist, there's a tension there from people worried that they're being judged about their mental health, that there's something wrong with their mental health. Like, they're broken as a human. common thought, I see a pattern emerging from my patients. Whereas when they're coming to see me,

it's their general health. Yeah. And then I introduce the topic of mental health is general health. Yes. So their guard is down for that conversation. Yes. But when I say, hey, I think you would benefit a lot from seeing psychologist, psychiatrist, the guards can sometimes come up. Yeah. Even though we're doing the same thing that they would do in those visits. Yeah. Yeah. No, I know. I've experience. I've been on the other side of that. And yeah, it's, it's tough. It's really tough to build up that trust. And I think that gets to what has been shown in media a lot about what therapy is. I should, you know, I keep saying therapy. I'm implying psychotherapy, but there's other forms of therapy. There's physical therapy. There's occupational therapy. There's all that stuff.

but yeah what's been shown in media about how a mental health expert what they look like how they act all the sort of stuff there's there's a gap you know and this is why we make our reaction videos to help people understand this stuff right um but yeah i think you brought up an important point and i think that that speaks to the generalist where you um you don't need to be an expert in all of these things. You do need to know the limits of your competence, but here's another problem. We take a colleague I might love and admire, and it's very easy to get to a situation where you're now dealing with things that are outside your competence. This happens a lot in mental health. You start seeing someone, they come in for having anxiety. I diagnose them

with generalize anxiety disorder. They struggle with worries. They have a hard time dealing with tension. They have a hard time making decisions. Their sleep is bad, all that sort of stuff. Okay, generalize anxiety disorder. We wait three, four weeks. Well, we don't wait.

We're doing our treatment. Sure. We're a month into it. Now they're experiencing a manic episode. Now I realize that they have bipolar disorder. Now the treatment has to completely change. What am I going to do? Am I going to refer this person out when they trust me,

when they were on my wait list, when they finally saw me and were making some progress here, or am I going to continue seeing them and try to get some supervision, some consultation with colleagues to sort of help me through? I've been in that situation many times, and it's very difficult because most of my colleagues, that I would want to refer to are full.

I can't just walk someone down the hall and say, can you help? And a relationship is formed and you can't abandon your clients. So it's very tricky and it speaks to a lot of the problems in the mental health system. In the same way that when a patient comes in,

look, to be a generalist, I can't have all the answers. But there are very few things that we can't together with our reasonable sources, like our up-to-date that exists, where I could look up what the epidemiology is, what the treatment looks like, what the diagnosis should look like, at least the beginning steps of it,

to guide them while they're waiting for their three-month wait time for their subspecialists. Is there such thing in your world where, like, if they're not being evidence-based with their OCD treatments, that they can look something up and find it? Yeah, absolutely. So just that they're not, they're choosing not to.

Well, no, so, all right, this speaks to a lot of the complexities here in mental health. There absolutely are. There are some treatment guidelines, which is usually what happens in health care, right? Like what are the different lines of treatment? What do you try first before moving on, right? There are some of those. And to be quite frank with you, development of those has been completely lagged behind

because of all the politics involved because one of the things that we have in mental health is your theoretical orientation. Are you a psychodynamic therapist? Are you a cognitive behavioral therapist? So I identify as a behavioralist. And so

that is one family of people in cognitive behavioral therapies. There's also cognitive behavioralists. There is also a third way. There's also a third wave of truthings. Take through the audience a difference between a cognitive behavioralist and a behavioralist. Okay, so if you go way back in time and people might have took introsyke,

you might remember people like Skinner and Pavlov and like training pigeons to like play ping pong and stuff like that, they were the behavioralists and sort of believed that with the right environment, you can change behavior. And we can we can sort of guide. behavior in this way by controlling the environment. There's a super cool person named Mary Cover Jones, a woman who does not get the credit she deserves, who saw all this and said, maybe we can use this to help people overcome their problems. And so from their behavioralism as an approach to psychological problems came to be. It was all about helping to guide and change behavior. Then later on, you had the cognitive therapy that came online, Aaron Beck,

was a big pioneer in this area and so that was all about can we change the way people think and that'll change their problems so it's all about the internal universe behaviors are all about the external what's going on here like um change the environment versus change your thoughts and then there was like an integration of the two cognitive behavioral therapy that's how it was born so why do you identify yourself as more of a behavioralist if you want to get into the I do. You want to go deep here? I think thoughts don't matter.

I really don't, for the most part, I don't think thoughts matter. They're sort of the background noise of your mind. Riding the subway, I will always get this weird thought that, like, it would be really bad if I just, like, fell in here. It would especially be bad if I fell in as a train was coming. That's just a random thing.

thought that popped up in my mind. It doesn't really mean anything. The problems become often when we get too stuck on some of those thoughts. That might lead to a lot of distress, things like that. I don't, and I also haven't seen too much success from helping people to think more rationally. And I think it's quite invalidating to a lot of people to say like you're having totally irrational thoughts. Like don't think that way. they're having the thoughts are having it's probably for a wide variety of reasons let's help people to stop the struggle with those thoughts and learn what they need to do to focus their attention develop skills that they need and help them gain experiences that will lead to the outcomes

they want so it's it's not that thoughts totally don't matter i'm an anxiety guy and latest research and anxiety is all about this thing called the inhibiting inhibitory learning approach or inhibitatory learning theory. I'm blanking on what's the correct term here. But the idea is basically we overcome anxiety problems not from habituation, which was the old idea. That was the idea that you do something over and over again and your nervous system reacts to it less and less.

so you're afraid of dogs just interact with the dog over and over again and your heart rate will come down your anxiety is going to come down all those symptoms are going to decline and you'll be better that used to be the idea of anxiety for decades now we we believe that it's more about inhibiting the feared memories so you need to interact with the dog because you have this belief that the dog is going to bite me the dog is a threat and and you might not know how to deal with dogs but what we know through exposure is if we help people to activate those memories and also teach them how to interact with dogs now that memory of a of a dog biting me will become inhibited your brain will be like oh you don't need to worry about that as much because I've gained all these experiences and what I've learned is there's a proper way to pet a dog. You usually want to check in with an owner. Is this okay? You know, there are, there are ways that animals become scared of us and if we approach them in a certain way, they're going to be more

calm and more responsive. So that's, that is important. Those thoughts are important. Like memories are important. Memories are kind of the name of the game in mental health. And yeah, we we need to engage with memories, but we don't need to go around, mucking around too much with thoughts. And I think that message of getting better is as simple as changing your thinking is a big problem. I agree. Which is a lot of TikTok content. Yeah, it is. And I actually talk a lot about how thoughts impact your actions and your feelings and the cognitive behavioral therapy model. I view the entire like field where you're talking about the habituation to this inhibitory therapy or thought process. I view it as it has to be like all or nothing and it's never really that.

It's almost like saying blood pressure is high because of calcifications in your arteries. Well, yes, but it could also be high because of renal artery stenosis. It could also be high because you have a large body mass. It's like a fever. Yeah, exactly. Like, could be good, could be bad. Right, right, right. So, like, everything you said is very logical and stems to be true.

And at the same time, like, why I feel journaling works quite well for patients is so often they feel anxiety, but don't have any insight into what is driving their anxiety. So even if we don't necessarily say this is a completely irrational thought, you need to eliminate it, not in a judgmental way like that. just have them realize where it's coming from and give them some power to thought about it. Yeah, yeah, yeah. I mean, I always tell people if you can't access a therapist, the next best thing is journaling. And so what's happening there is people are creating meaning.

They're understanding the impact that different experiences have. They are gaining more awareness into how their emotions work. All that stuff is super valuable. When I said thoughts don't really matter, it's the moment to moment. thinking and trying to go in and like mess with that in the moment. That I don't think, Matt. And that's what the stereotype of CBT has become. That's what I hate, Dr. Mike.

Well, that's because it's been hyper simplified to make it acceptable to the masses when you're explaining the broad concept. Yeah. But that is just to be the sort of the appetizer, not even the appetizer. I don't even know what's a good metaphor here of intro. The free sample. Yeah, like the free sample at the store where it's not really going to be the mainstay of your treatment. What I will always see described in a lot of articles is CBT, which helps you to think more rationally.

Yeah. You know, and it's like, well, I say that, I do think that's good in many ways. Okay. And the ways that I see, because I'll point out both. Yeah, yeah. I don't want to play, I want to play devil's advocate. Yeah, yeah. The good way is that when you say that I'm sending you.

you to therapy, patients go, oh, I don't want therapy, talk about my feelings. I'm like, no, no, no, it's actually very rational based. And they're like, oh, yeah, that doesn't sound as scary anymore. Yeah. Okay. So that's, that's good. You know, I often describe therapy as like, it's, it's kind of like working with a coach. You know, you, if you want to improve your tennis game, you go see a coach who is an expert in this. They're going to show you, they're going to show you some drills, like what to do. They're going to give you feedback. You're going to get better. that's exactly what therapy is it's like working with a coach but for your feelings but for your the actions that you take you they teach you how to get better at the stuff that's about it also

because you got yourself into this when you said coach what about life coaches oh yeah yeah yeah yeah we need to talk about that yeah so all right because i've seen decent advice from life coaches yeah yeah yeah yeah yeah at the same time when you start philosophizing as if you're the next coming of Buddha. Yeah. I not only see through it from like a monetary, like, prescriptive way, but I also worry, are they actually helping or are they creating a cult? I'm Chris Hadfield. I'm an astronaut, an author, a citizen of planet Earth. Join me for a six-part journey into the systems that power the world. Real conversations

with real people who are shaping the future of energy. No politics, no. empty talk, just solutions-focused conversations on the challenges we must overcome and the possibilities that lie ahead. This is on energy. Listen wherever you get your podcasts. Yeah. One of my favorite articles in mental health is called rebooting psychotherapy. And the premise of it is if we could start from scratch, what would the mental health system look like? Oh, yeah. That's cool. Right? Because it, like, walking in to see someone and sitting, sitting down in office for 50 minutes is like pretty inaccessible. It just, it doesn't happen in most of health care. So if we could start over, what would we do?

And they talk about the role of technology. They talk about media. They talk about a lot of stuff that you and I do. They talk about the growth of non-professionals who are providing mental health support. so that article came out 2014 something like that and not because of it but what we've seen is this growth of coaches of non-professionals who are providing a lot of mental health support and as I said before and I've said many times in a lot of different spaces mental health doesn't belong to mental health experts so I think there's a huge role for people like coaches to provide help related to mental health problems and we You should probably define what the heck we're talking about with mental health. You know, mental health is about your thoughts. It is about your feelings.

It's about your actions. It's about stress. It's about how you overcome that stress. It's about the important relationships in your life. That's a lot of really broad stuff. And there isn't one field, one person, one context that sort of owns all of that. So I absolutely believe we need people who have a very, variety of training with a variety of expertise in a variety of settings who are helping people

with all this stuff how do we make sure people end up with the right people that's because that's great that they exist yeah but it's not like they're filtering in through some kind of like squares are going to fit into square boxes right yeah and that's that's the big question uh right now it is very easy to be a coach there are some training programs and credentialing programs you can go to, but you also don't need to. And you can operate as a coach without any type of license. In fact, you often see someone who has lost their license to practice psychotherapy become a life coach, which is a problem. So I don't know the answer to that question. That is a big problem for us to deal with and it's I see it as a symptom of a larger problem with us never having

really fleshed out what a comprehensive mental health system looks like in this country yeah we've come close many times it was the very last law john f kennedy signed was this program for a nationwide community-based mental health clinics it's never really come to be um and so what we have We have two big problems on the spectrum of severity. We have a lot of people with things like bipolar disorder, schizophrenia, really chronic depression. That becomes very disabling, very impairing. These people might be vulnerable to becoming homeless. They might end up in prisons, which are our largest mental health system in the country.

All the largest psychiatric systems are. are prisons, and we're not serving that population, like a third, I think, of people with what we call major mental illness, these kind of problems, never get treatment. And then on the other end, we have a massive population of people that are just below threshold. People who are struggling with anxiety, but don't quite meet the criteria, but they're really suffering. They're struggling, they're impaired, they need help, and they can't access it either. So it's a complicated problem. We've never really built out a system that that catches the people when they need to. And so a lot of people go untreated. It's very common, especially in anxiety, for people to go years or

decades before they ever seek treatment, before it's ever really caught and identified. And so coaches definitely fulfill a role there. How do I identify what's effective, what's evidence-based, who's the right fit for you, what level you need? It's hard. It's hard. Well, the reason I bring up the health coaches is from a personal aspect, anecdotally, so not evidence-based.

I've seen a lot of people in my media world or maybe social media world that don't have even a family medicine doctor, but they'll have either a health coach or a mental health coach. And I see that they're helping them cope to some degree, but they're also building in some pretty bad habits that ultimately might make them feel good. And that's why they keep going back and paying. And that's why they've created this financial incentive model for themselves. But it ultimately, I feel like, is doing them a disservice. And I don't know what to say about that because without throwing the whole field under the bus,

how do you actively critique it? Yeah, if I could design the best system based on my experience, it would be one that would follow this person I love, I love his work, his name is Vikram Patel. And what he did is he took some of the most effective treatments we have for depression, something called behavioral activation, which really helps people to take small steps towards becoming more active

and feeling more engaged and more fulfilled. That's all behavioral activation is. Pretty effective at treating depression. And then also motivational interviewing, which was something developed to actually help people to stop smoking, and it's been a great way to move people from pre-contemplation.

You know all this stuff. So he took these treatments and trained community experts in India to do them themselves. And so what happened is the people that you would go to anyways for help, whether it might be like a religious leader or a local leader in a community. I don't know. I'm thinking of New York. I'm like, who are community leaders? I don't know. This is a social media influencers. Social media influencers. Right. Right. People that you would go to anyways, now their messages are infused by evidence-based stuff. And what he also

trained them to do is if this isn't working, here's how you level up. Here's where you. Yes. Right. Right. Because these are the models of health care that work in environments where there is no health care. You train the community leaders in the basics. I want to go one step further. Yeah. Why can't we just teach this in school? So. So. Because if we're teaching you that.

I want to give you a big hug right now. Because that. Because wouldn't that then fuel the community leaders anyway? Yeah. Yeah. So here's what we got to do. This is, we're solving mental health right now. This is what we're going to do.

Okay. New York State was a first state to require K through, K through 12 education and mental health. I love it. And that model should be taken nationwide. When did that start? Because it definitely missed me. Yeah, yeah, yeah, in the late 2010s.

And it was a requirement to make it developmentally appropriate to at kindergarten through 12 to give people education and thoughts, feelings, behavior, all that sort of stuff, how all this all this stuff works. it sparks conversations, it makes it just a normal part of the curriculum, all that sort of stuff. That needs, that's number one needs to happen nationwide. There's, God, I wish, so I grew up as a social anxious kid. I wish I knew I had social anxiety. And it wasn't that there was just something wrong with me, which is by definition what social anxiety is, right? But I didn't know that this was a thing and there was a treatment. Other people shared in it. Other people shared in it.

Other people shared in it, right? Yeah, that, like, I could go to someone for help for all this sort of stuff. So I would have really benefited from that. So it needs to be a part of the curriculum. The other thing we need to do is make mental health a part of developmental milestones through your life. Here's what I mean by that. When you go, when you have a newborn and you go to your pediatrician, they're asking, you know,

Are they, how are they eating? How are they feeding? Are they looking at you? Are they crawling? Are they grasping at things? Can they imitate you? All this sort of stuff. Well, we do this family medicine.

Right. Yeah, yeah. This is all you. Can they stack four blocks? Yes. Can they crawl? Yeah. Yes.

Yeah. Very specific outcomes. Yep. And why do you ask these things? To flag potential avenues for early intervention. Exactly. And this is what we need to do through the lifespan, specifically going into age 25. But it should be related to mental health outcomes.

So what I always look for when I'm working with someone isn't necessarily symptoms. I do have to make a diagnosis. And diagnosis informs the right treatment. But the real magic for me is functioning. Is this six-year-old able to go to school? Are they able to separate from their parents? Are they able to make friends? Are they able to do all the things that are expected of them relative to their peers?

Is this middle schooler? Have they maintained friendships over time? Are they withdrawing? Are they more isolated? What do their grades look like? is this high schooler, do they have a good sense of their identity? Are they, do they know their, their sense of,

are they experimenting with their sense of beliefs and identity and all that sort of stuff, right? We're looking to see how this person is functioning in the community and culture they're in. And if pediatricians and schools were looking, at these developmental milestones as they relate to mental health, I think we could pick up on people and intervene early before it becomes a bigger problem,

which is the goal of measuring developmental milestones, right? Is this person, do they need more help now? Let's not wait 10 years. Let's intervene right now. But what happens, Dr. Mike, is that people do wait 10 years. Anxiety, depression, these kind of things, They don't really get you noticed. ADHD might, autism spectrum might.

So learning disorders get picked up. Behavioral things. Behavioral things. Yeah. So we often talk about externalizing and internalizing problems in mental health. Externalizing problems is the stuff that gets noticed in classrooms.

Kid's not paying attention. A kid is causing a lot of oppositional problems. They're starting fights, things like. like that those are externalizing the problems are coming out and impacting the external world the internalizing stuff the anxiety you know i'm not good enough um that dog's going to bite me i'm afraid of cockroaches so i can't be i treated a lot of cockroach phobia in new york city yeah so it's a very impairing problem because if you think of cockroaches in the room and you can't go in now there's a lot of places you can't go to so those are internalizing problems people don't see it same thing with

depression, those kids often slip through the cracks. And those problems build and build. And what happens is people are functioning less. They're not making friends. They're not taking the developmentally appropriate risks. I see this

stuff really flare up in middle school and high school when relationships become a lot more complicated. And then we just expect kids to go out to college or enter the workplace and be able to like function. And they just they can't because these problems were never intervened with when they needed to so let's make it a

part of school curriculum let's make it a part of developmental milestones not just screening don't just screen for symptoms but measure developmental milestones related to these behavioral goals then we'll pick up on a lot a lot of folks who need help and can get help right when the problem starts because you don't want to treat a broken bone 10 years after it's broken. Yeah. But that's what we do in mental health all the time. Yeah. Because then you're re-breaking that bone, resetting it, yeah. Putting in hardware. Yeah, yeah, yeah, yeah. Much more invasive, higher rates of side effects. Yeah. All those issues. Surgery, all that. Yeah. Exactly. Yeah. Yeah. That's true. Okay. So we solved mental health. We did. Yeah. It's just, it's going to require a lot of money. Um, it's, part of it is

unrealistic. Yeah. To some degree. Putting on teachers who are are overworked, underpaid, and have class sizes that are exponentially growing, is unrealistic to say, hey, are you watching Timmy and Deborah's developmental milestones? From like a realistic perspective, I don't know how often that's going to happen. But making sure that in every curriculum, they're knowing the ideas of how feelings, thoughts, and actions intervene in life, or the behavioral model, anything like that, to peak curiosity, peek in understanding, drive some introspection, that would be. A reasonable game changer.

Yeah. And the easiest way to do the teacher part is, yeah, we don't want to put the pressure on teachers. If you're a parent watching this, talk to your teacher about how your kid is doing relative to the rest of the class. It's as simple as that. Are they making friends? Do they get into a lot of arguments? Can they express themselves a way other kids do? It's those kind of things.

Teachers always have the best answers to all those questions. And it's the number one thing I do when I'm seeing a kid is I call up the teacher. Well, I don't call up the teacher. I get the approval from the parents to talk to the teacher. And then I call up the teacher. So there's ways to sort of get around this. Do you feel like with that kind of approach and in general kind of the approach that exist today with people of means and I specify people of means because most people don't get this

level of access. Yeah. There's quick action to create pathology where a kid gets into a fight, a kid talks in class too often and there's diagnoses and labels being thrown around very quickly, parents catastrophizing, worrying that there's something wrong with their child where it's like, well, let's see if this is a true pattern before jumping to conclusion. Do you see that happening more these days? From maybe the information being too out there and the labels and the WebMDs of the world? The vast majority of schools I've worked with

are pretty good in this department. Teachers talk to one another. This starts in kindergarten. They know which kids are struggling with what. And they try to deal with that as best as possible. And usually they'll refer to someone like me. They'll say, like, you need to go see Dr. Elie for this. They'll usually refer when the problems continued over time,

when it's become a chronic kind of thing. I don't see too many schools making that call. Every school I've worked with has tried. Maybe there was a few exceptions here or there. Parents, on the other hand, I've found, are more hesitant to either start treatment with me or with a psychiatrist. And they're usually a little bit more concerned about what this might mean,

what the implication would be, is there going to be like an identity that sort of the kid is now stuck with? Yeah, created. It's going to follow him. Concerns about medication for things like ADHD, stuff like that. I don't see it too often.

I'm not too worried about that I was working with my therapist and I said there's two things we need to talk about today my gray's and my ear hair okay yeah and he's like okay

I'm like yeah I just like I notice a hair of my ear and I'm like what the hell is this all about and so like it's stressing me out and he's like okay I'm getting the impression it's not just about the ear hair but what's the thing underneath the thing I'll eat

oh wow so he asked you about a thought Yeah. Oh, interesting. The anti-thought guy was sharing the thoughts. Thoughts are important. We just, no, I understand what you. Yeah, we just don't need to like think about changing. But that gets me to something that does really annoy me.

Okay, tell me. That's affirmation stuff. Oh, okay. Yeah. That's popular. It's really hot. I mean, celebrities are doing it. They're writing it on their mirrors.

Yes. Yes. I don't think, like, there's one. one influencer person who's not doing it. Yes. I did a little bit of a test where I made this post that was about like coping statements. Okay. Things that you can tell yourself when you're feeling anxious.

I know I'm the anti-thoughts guy, but these are all things about good reminders of what to do when you're anxious, right? It performed okay. I kind of made the exact same piece of content, but I called them anxiety affirmations. Like it took off, right? So yeah, it's totally hot. It's totally in.

What annoys me is similar to what annoys me about the perception of cognitive behavioral therapy, which is change your mind, change your thoughts, change your mind, change your life. There's also stuff here about like mindsets. that's really hot right now and whenever you get into this territory if you just think the right way

your problems will be solved I think it's way too much on the side of like pull yourself up by your bootstraps like you fix your problems it's not that easy to fix your problems the problem I have with affirmations is

is any post that makes you think that if you just keep repeating this you're going to like good things are going to come your way uh we saw that years ago with like the manifesting stuff which now i feel like it's more like a punchline like oh yeah i manifested yeah yeah yeah but like with the secret it became this like thing i just need to believe this and like good things will come down yeah um people i work with there's very good reasons why they're struggling with their mental health and just repeating something over and over again is not going to

help. It's not to say that affirmations can't be helpful for some people. I think for a lot of people, yeah, maybe it's helpful. I think what can be more helpful is conversations around them. So if you have an affirmation, which is like you are beautiful, you are smart, and you're making a difference in the world, and you read that, and you don't believe it, or it might make you uncomfortable or you don't want to look at it. I think that's useful. Like that you can talk about. Like there's stuff there worth digging around and discussing and understanding.

But just the idea that you repeat this and you are going to overcome this problem, for a lot of people, that's just not the case. Is it safe to say that if affirmations on their own reading you are beautiful, you're successful, are helping you, you don't have a problem? Yeah? I mean, that's like the thing here is like, I don't want to burst anyone's bubble. Like if something is helping you

and it's not impairing you, that's a good thing. Like, okay, I should probably define what a coping skill is. Coping skills are things that help you deal with difficult situations. and promote flexibility. So let's say you're someone who struggles with social anxiety. And if the only way you can cope with it

before going to this party is having a few shots, is that a really flexible solution? I don't think so, right? Because then what if you don't have access to alcohol or what if that causes... Or it causes other impairment or you're putting other people at risk? that's not really the best

but if you this happened to a patient of mine where we had this big conversation they had agoraphobia needed to fly two times a year that's it otherwise they don't need to fly at all

the only way they were able to fly is if they had a shot before the flight and then a shot of alcohol on the flight on the flight with that they kind of knock themselves out they sleep on the plane they get through it we had this big debate about whether or not that's effective coping because it's only two times a year they don't have to do it elsewhere it's a 100% proven way of coping right so i think so wait is it well i said you

know maybe you want to consider some anxiety medication maybe you want to take something that is more under the guidance of a medical provider why because then you can you have the Medicaid what if what if they're on a flight and there's no alcohol

or what if like they're playing the flight is delayed and now they keep drinking they don't know when the flight's going to take off it's in those situations is not as flexible but if they can take some anti-anxiety meds that help them in that context

and they have control over it, now they've got more flexibility, you know? So it's also a situation where there's no right or wrong answer. Yeah, that's why I was going to say. Yeah, because you could make arguments for both that are decent. Totally, totally, totally.

And what might start as healthy coping in one situation might not become healthy coping later, right? So your question about if affirmations, do they, if they help the person, then are they good? Well, yeah, as long as there's flexibility there. So if you're, if you need to have that affirmation like in your pocket and you like lose it and now you're not able to do the thing, well, that would be a problem. But if it's, if it's helping you meet your goals and it's not hurting you, you have a lot of flexibility, it's not hurting anyone else.

I don't see anything wrong with that. I view affirmations based on how you described them to me the same way I view cold water immersion or ice baths. Yeah. If a patient comes to me and says, I do these, and this is why I do them, all the stuff. And I say, do they make you happy? And they say, I really like doing it. I will never tell them to stop,

unless obviously some weird medical thing happens where they're like having a cold water erotic carrier or something, or whatever, some rare condition. Yeah. Or they have really weak cardiovascular system and I'm worried. Again, very extenuating circumstances. But if they come to me,

they say, should I do this for my health? The answer almost always is no. Because it's a distraction from real things that would give good outcomes. Yeah, it wouldn't be your go-to. It wouldn't be ever, ever, ever. Do you know about the dive reflex? Yes.

Yeah, do you, would you be... Yeah, like we use dive reflex to lower someone's SVT, which is a super ventricular tachycardia. Yeah. So that we could make use of certain reflexes in the body. But that's not why people are doing. But that's not an ice bath. No, ice bath.

When I say ice bath, maybe, I didn't explain it well. Like there's a field or there's a growing panel of experts on social media that are quite popular that are obsessed with cold water immersion. And now every TikTok is about like if you go in with this protocol with two minutes, three minutes, 15 seconds, point four, if you're not doing it this way, if you don't buy this model. And it's based on no evidence, junk science, similar to the Meyerberg situation. And it's a distraction from real health. and while there might be some benefit to going and challenging yourself mentally and to go in cold water,

that's not the answer. Yeah. And if that's the answer, yeah. There was probably never a problem. Like you're not going to cure your cancer by going into the ice cold bath. You're not going to cure your hypertension

by going into, if you have low thyroid hormone or low testosterone, it's not going to cure it. So if it's helping you, it's helping you because you enjoy it. Right. And not because there is a problem. This is a problem with health information

that is trendy. People ride these trends, they go up, and it can really do a lot of harm. At best, it can be neutral, but at worst, it can do harm. The dive reflex is a skill we use a lot in dialectical behavior therapy as a way of quickly bringing down

someone's intense emotions when they're at a place, when they might cause harm to themselves or other people. Not at all the thing that I was talking about. Yeah, yeah, right? But we always say, we always say

if you have a health condition talk to your physician first because you don't want to quickly bring down your heart rate but again not at all the situation and like that'll get lost in a 15 second TikTok

of course right but that's not what all these experts are saying just very much separating yeah yeah no they're saying for general health for curing depression like ridiculous things yeah and like okay so how how do you square that up

with like a Korean spa where they might have hot baths, cold baths, stuff like that. It's been around for like hundreds of years as a way of like, you know, I understand a cultural thing. Yeah, yeah. What about that? What about it? I don't know. No, but what's the question?

Well, if someone says, like, I'm doing this, it's helping me. Good. It's good for my health. It's good for my mind, body, and all of that. Yeah. I just would never recommend it. Yeah. is the difference.

Like if you're doing it and it makes you happen, it's the equivalent, the way that I see it, is I can most definitely pick out out of some research that baseball is a better sport, soccer is a better sport for your health than baseball, right? Sure. I'm sure I can find some metric, pulse, whatever, lower resting heart rate, something.

Yeah. But if my patient says I play baseball versus soccer, am I going to say, hey, no soccer is a lot healthier? Yeah. Never going to see them. Why? Yeah, what about American football? Well, that's a different thing because that's about risk versus benefit.

Yeah. They're preaching these things as a benefit. I'm with you and I would also never recommend affirmations. It would never be a part of what I do. We do sometimes write things down so people can remember it and think about it and stuff like that. But as affirmations are practiced in social media, that is not going to be a go-to for me. If it's helping someone, great.

Great. Yeah, as long as it's not limiting you. I'm going to ask you a few hard questions. And then we'll end on something that I'm curious about, but probably the most of the audience won't be. What is your take on the world of punishment as it exists today? For kids? No, uh, societies, like jail punishment because, and I'll explain why I say it, just to give you some context and probably give you a chance to see where I'm coming from.

What a transition, Dr. Biden. Well, you put it in my mind when you mentioned that the biggest, uh, psychological health service in this nation is our jail system. Yeah, yeah, yeah. And we know that most people acting out, uh, most people committing crimes, most people with their extrinsic behavioral issues that are witnessed to the world, oftentimes were the ones who've experienced trauma themselves. Yes.

Or who've had emotionally neglectful or physically abusive, sexually abusive childhoods, maybe even adulthoods. Yeah. And then now they're acting out on these situations. So how valuable is it to continue punishing those people who've, technically been punished inadvertently throughout their whole lives versus making the decision between someone who has had that in their childhood versus hasn't had that and how do we make that distinction who do we choose to punish if not there are other models here and and there are some European countries

that focus a lot more on rehabilitation versus punishment locking people up when I was an intern intern and as a psychologist is your last and sort of final year of intensive training before you get your degree and before you're sort of out there. I was interning here at Bellevue Hospital and I did a rotation where I was just working with forensic patients, people in the correctional system. Whenever I looked at the patient's chart and looked at the experiences they've gone through, It's like trauma, poverty, neglect, like all these layers of things that we do know lead to very difficult problems. Sometimes like head trauma early in life, maybe from physical abuse, things like that, you know.

So rehabilitation really needs to be the name of the game. this gets back to the larger problems we have with mental health, that we don't really have a system that catches people and intervenes when they need it, both for very severe problems and also the more minor problems that we've been talking about. So if we were able to catch people earlier on, and there are some places that are making changes, there are some law enforcement systems in our country that do have mental health units where people are dressed like you or me and they're not coming and responding to a crisis in uniform which already puts people on guard on edge and is loaded with all the expectations that come there but they're

trained experts in dealing with mental health crises that come in and help the person get the services the help that they might need in that situation If we do more like that, we won't be sending as many people to jail and then subsequently to prison for having a mental health crisis, for the symptoms of their problem. Well, that's a very PC and positive answer. I want to know your personal belief. Does all the traumas you brought up, does it absolve people if they do something? Oh, I see what you're saying. there are certain things we just can't allow in society,

pedophilia, you know, people who are killing other people. People who are doing harm and whether or not they can control it, they do it. and it's either very severe or it keeps happening, those people probably should not have free access to society. There needs to be some limitations put in place. And that's a very tricky thing to say as a psychologist because there are always extenuating circumstance. Yeah.

Because I never really understood the insanity defense, right? It's still called insanity? Well, it's a, so that's illegal. That's a total, it's mental health, the mental health field has not defined what insanity is. Well, that's why. I don't understand it. Yeah, yeah. That's a legal, um, court decided thing.

Which is, is it, shouldn't it be based on science? But then if it's based on science, can't we go back and say that if you're performing cannibalism on a person? to some degree, you have to have a layer of insanity to do that to another person? Well, I think a lot about frontal lobe damage, head trauma, these kinds of things. So if someone, so this part of your brain right here for people watching is your frontal lobe, most, it's the most, I think, human part of us. What separates us from a dog? Yeah, yeah, yeah.

That and a few other things. But maybe the dogs are better off. I don't know. I relate really well to bear. Yeah, yeah, yeah. I know. That should be a whole other episode. We should talk about like, if you just talk about dogs.

Yeah, we're talking about the heaviest of all subjects. Right. But no, let's get back to murder. Yeah. So, you know, when I understood how much damage to the frontal lobe, this part of your brain that controls your emotions, it puts on breaks, it helps you to think about future consequences, when damage there, either from blunt force, from chronic drug use, from, from dementia, from aging, from all of these kind of things, how much that's related to a lot of these social

problems and breaking social norms, you know, that's like, what do we do with that? Like, responsibility, responsible. That's my question. It might be an impossible question to answer. Well, and then also the research on psychopathy, so cold-blooded and warm-blooded people. So there are some people that are just born with psychopathy, where they are a bit more cold-blooded, meaning they don't activate intensely when stuff happens. They might see something horrific happen in front of them.

and they're just calm, cool, collected. And these are people that are both at risk for committing crimes because they don't react to stuff the same way you or I might. They also might be very good in business, very shrewd business people because they make very logical decisions. Or baseball batters. Or baseball batters or astronauts. You look at some of the...

Or victims of crime. Yeah. Because they might not report. they might not have that. Right, right. So you can see how society needs all types of people. We need all types of temperament. Teams work best.

When you have people on the autism spectrum, when we have neurotypical people, when we have people with ADHD, people who see things differently. We need that. We do also need to draw the line. That we can't allow people to harm one another. And I recognize the line is arbitrary, to some degree.

Yeah, and changes over time. That's the whole thing with mental illness is homosexuality used to be in the DSM. It used to be a mental health disorder, and it's not. And yeah, the science moved, but if you listen to my favorite episode of This American Life, I think it's called 81 words, and it refers to the 81 words that defined homosexuality as a mental illness, that story, that episode goes into how it was removed from the DSM. And it came down to relationships and politics and helping to move a field and realize that like this is not, this is not leading to the problems you think it does.

And the science was already there, but it, we had to move the cultural, we had to move the cultural shit. And this is always a thing with mental illness. It's always being redefined as. culture is being redefined. Well, that's why words are redefined. I mean, mental retardation, word crazy, like, these are all terms that have changed over the years and some people still use them incorrectly or correctly, however you choose to use

them. So it's hard to stay up to date on it. But in general, I still want your concrete answer on that. Do you believe it absolves people of their wrongdoing? No. it might not be their fault and at the same time it is their responsibility. That's a fair way to look at it. So I come back to that all the time in mental health, that it wasn't my fault.

I grew up with social anxiety and it's also my responsibility to do something about it because no one else is going to. No one else cares. This is actually a situation that I've kind of squabbled a little bit with my behavioral specialist in my hospital where I frequently advocate for that individual responsibility from being a primary care doctor, like what tools can I give my patient to be a little bit more successful? Like the idea of boosting a child's self-esteem by getting them to enroll in Taekwondo as an example. And his take is that's less of impactful than changing systemically why they're being bullied or going to the

school. Yeah, I completely agree. But we don't need to choose one or the other. Let's do both. Let's arm people individually and make systemic change. So maybe we put too much weight on the individual or the systemic change, but like both avenues, I think, work. Yeah, and I mean, this is what gets lost in all these conversations. This is what gets lost in the soundbites is the nuance and both are true. We should be working on both ends. We should arm people with coping skills. And we should also do things like give people who are in poverty more resources.

There's a lot of research that shows if people in poverty just have more money, that they're less stressed and they make better choices and they experience less problems. Okay. So let's do both. Like, you know, so it's, yeah, that stuff gets lost in these conversations. Okay, that's fair. And then my second hard question is we talked about therapy being somewhat broken and people having difficulty access. I've been approached a dozen times by better help or the like of better help

to get people digital counseling. Yes. And on the face of it, I'm like, this is a no-brainer. I should do this. I should get more people access to this. I should talk about it. And I've never taken that endorsement.

And I've seen really respected mental health specialists that I watch their content take these ads, whether it's on podcast or YouTube videos. And I don't know if this is something that's worthwhile to be recommended or not. Oh, you never seen me take those. So you and I are both in the same.

Yeah. Well, I've actually seen you speak negatively about them on Twitter. I saw you wrote a tweet where you were pointing out, cough, cough, better help as a way to increase access, but it's really not. Yeah. What's your criticism of it?

So there's two criticisms. One is of just where that part of the field is at, and then there's more of a specific criticism towards better help. Okay. So let's talk about both. And I'm glad you haven't taken that sponsorship. Because I think people like you and me who talk about mental health issues and mental health care, which you do a lot. We should have the freedom to criticize whoever.

we want to and go wherever that conversation needs to go. And it gets tricky with YouTube because, yeah, you can sometimes have controls over the ads that play prior to our videos, but it's also kind of tricky and hard to do. That's a whole insider conversation about YouTube we can save for after the show. But let's stick to the question you asked me. So that article I mentioned before, rebooting psychotherapy, if we could start over, what would we do? One of the things it outlines is tech. Like there are a lot of ways in which apps might be able to help people who are struggling with these mental health problems.

Where that is right now, and I worked at a mental health startup for two and a half years, I was venture-backed. I know how that world works. Where we are right now is a lot of these platforms like BetterHelp exist in a way that's just perpetuating the same. same problems of in-person care. It's also perpetuating the same benefits, but is this a digitized version of the real-life stuff? So let me give an example. If you want to learn a new language, you can go to a teacher, a language tutor, and they'll work one-on-one with you, give you the lessons, the drills, the vocab, stuff like that, give you feedback on it, right? Well, the first generation of digital products for that just had CDs that you would buy and you'd pop them in and the software

would be just a person that's teaching you the same things. It wasn't really changing that in many ways. And then the more recent generation of stuff is things like duolingo where it's sort of gamified the whole experience and it teaches you a language in a way that couldn't be done before and it's very scalable. It's cheap to make this in a way that reaches like millions of people. Like one teacher couldn't reach millions of people unless you're making YouTube videos,

but you couldn't give the direct feedback. Can't give individual feedback. Exactly, exactly, right? So you have these three generations, the in-person, the second generation, which is just redoing the in-person, but just digitizing it. And then you have the third generation,

which is like a breakthrough product, that is something that could never be done before and it can be done at scale. Where we are with mental health, I think is a lot of the second generation. So you sign up for better health, it's a therapy marketplace, choose your therapist,

you see them on your phone, you see them on your computer, whatever it might be, you can text with them. You know, it is solving a pain point for the customer, making it very easy to find someone and just go.

And that's nice, but it's just perpetuating the same, pros and cons of in-person psychotherapy, which is you're seeing a person, you're working with them, they're giving you feedback, all of that. What I haven't seen yet is that breakthrough third category. Yeah, there's stuff like talk space. Yeah, there's stuff like calm. I think it's still just making content that isn't really doing anything that is personalized, effective, and at scale. Those are the three problems I ran into working at a mental health startup is we could do one or two of those, but we couldn't do all three. Mental health is such a complicated problem.

It does need some level of personalization. So I'm not going to, I don't think we'll ever see like one app that'll solve that. And I haven't seen like a breakthrough product that I'm thinking, wow, this is doing something that I never thought was imaginable before. or I would have never have imagined before. It's just a lot of that stuff is just creating content, just like stuff that I do anyways. Better Help has reached out to me a number of times as well. I've never taken their money because I want to be able to criticize this stuff

and advise people. If I see problems related to a mental health product, I want to be able to criticize it. This is one of the reasons I'm probably not going to, work for another mental health startup is because I want that flexibility and freedom. Unless you get that working at a company. Yes. Which exists.

There's a world that exists. Yes. Which totally exists. That can definitely be the case. I identify as someone who is guiding people to the next best step. And I want to be able to have that trust that I am not guiding you to someone who's paying me, which would be a better help, right? What my concern with them is twofold. One is how they treat their therapists, the expectations around you have

to respond to your patient's messages. And when the last time I looked into them, it was like within 24 hours, you have to respond. Otherwise, you get dinged. That was a huge concern to me related to patient burnout. I've also read a lot about some ethical things that they've done in terms of allowing people to practice in different states, even if they don't necessarily have licenses in those states. That is a larger issue. I'd like to have a national license for mental health professionals.

It doesn't exist. More reciprocity needs to exist. It's too hard to move and open up in different areas. they also like a year or two ago put a wide variety of mental they worked with some listing service that listed a bunch of people as being a part of this therapy network and they weren't i was listed on it i wasn't i think this is better help who did it i'm not sure but there's there's enough shady things about them that makes me feel not so good about better help

so to kind of sum it up I don't really think they're doing anything innovative I also have concerns about how they treat therapists and looking into their news I think they've had some ethical questionable decisions yeah yeah I think

it's good money though that they're offering me they're offering me a lot I believe it I, I view, I mean, I didn't know about the innovation aspect of it, that you were really high on the fact that it wasn't innovative enough as a product. To me, I'm trying to find, is this something that I could recommend to people to be a stopgap because they can't find access elsewhere? Yeah. And while I may not think it's innovative enough, is it something that I'm going to destroy and not recommend because it's not innovative enough?

But I think that's not necessarily the case because when you start commercializing health care and you start treating it like a hedge fund, I get worried for the reason that I don't know if you treat your patients this way, but this is something I've always set out to do as a doctor where I don't want my people. patients reliant on me. Absolutely. I want them to learn in the process with me. Trust me, obviously, and if they need to come in to get their questions answered.

But ultimately, it's not to get them to come back. Yeah. And yet, when the field of capitalism has entered healthcare, it's been about making them reliant on your service, whatever they may be. You may be a chiropractor, an osteopathic physician, a mental health specialist, working for better help. And when you start doing that, you start almost infantilizing your patient population to the point where they feel helpless unless you're there. Yeah.

And I worry about a lot of these tools where they're not trying to get you off their program. Yeah. So they are absolutely solving this pain point and making it easier to get access to a mental health professional. but are we really solving some more of the systemic problems which make it so hard to get access to a mental professional and if you're venture-backed

you have to scale, you have to grow and the same reason why I left my job in New York is the same exact thing I'm hearing from therapists working for better help the pressure around productivity and the number of people you have to see how responsive you have to be

all that sort of stuff It's out of control and people burn out and all that sort of stuff. I don't think we want to run mental health the same way we run Uber. I don't think we should be scaling things and commercializing things in this way. Some things don't really work well in a capitalist system. And I think health care is one of those things. Mental health departments, psychiatry departments, are loss leaders in most hospitals. The reason why a lot of my colleagues at Kaiser Permanente in California,

they went on strike many times over the last few years is because the expectations around the number of patients they see, how often they can see it was out of control. So you might come in, do an initial session at this HMO, this hospital, this closed system, and the next appointment that the therapist can give you is in like seven weeks. That doesn't make any sense, right? It's the way we are valuing mental health, like literally valuing it, where people on Medicaid are getting, the providers are getting 60 to 70 cents per dollar for the cost of services, where providing mental health care means you are losing money. That is the problem.

We need to start valuing this stuff. I think about it kind of like urgent care clinics, right, where they are definitely solving a problem. where you're able to get immediate help for a problem that you have. And I think in a lot of situations, it makes sense to go to urgent care versus an ER, if that's like the only choices you have. And that's how I sort of approach it. But there are people who approach it because they don't have a primary care physician. And so that's where they're getting all of their...

A lot of people I work with under the age of 30, that's their health care system. We talk about it a lot on this shot all that exact situation. I'm sure, I'm sure you do, because you probably see this and you hear about it all the time. Yeah. And so that's a, that is a symptom of a larger problem. Now, that's the fever. And there, let's see if this analogy works. That's sort of the fever, but there's a lot of causes that might be behind it, why people are getting going there.

I don't know if that makes any sense, but. To be introspective about this question, are we being unfair to better help by, pointing out the fact that it's imperfect when so much of the work we do is imperfect as it. The reason I've zeroed in more on better help is because of the reports of some of the questionable ethics. I don't have a vendetta against any of the other companies who do this. I think Ginger, for example, is doing really interesting stuff where they have both mental health professionals and they also have coaches. And that sort of expands your options as someone who is seeking help, like what level of support do I want? How much can I afford? What's the right

need for me? I think that's really cool. And they're doing in a very transparent way. I forget who Ginger merged with. It might have been Headspace. I don't know. Whoever they did, when I last looked at Ginger, I thought they were doing interesting stuff. My concern with better help is more the decisions they've made. But Dr. Mike, I understand the decisions they've made because their venture are backed. They need to scale. Their fiduciary responsibilities to the scale of the financials. It's got to grow. It's got to grow. And the only way to grow is to grow fast. Our generation move fast and broke things when it comes to tech and social media and we've broken social norms and all that sort of stuff. And a lot of that mentality comes from the need to grow

fast for investors to get a return on their investments. I understand that when it comes to health care. When it comes to people's lives, we can't approach things the same way we've approached social media, Uber, driving, all these other ways in which tech has disrupted norms. Yeah. Disruptor and health care can be really problematic in many ways. And unfortunately, very rare, too, because of all of these things. Exactly. And it could be a situation of good intentions creating bad outcomes too. Totally. Totally. So you're not against a telemedic telemedicine aspect. No, in fact, I think like a lot of telehealth, telehealth Medicaid or Medicare allowances might might go away next year. Hopefully they won't. I think the last time I was

reading about this, the COVID-era telehealth openings that happened have been fantastic. And I want them to stay. I don't want them to go away. I think telehealth is fantastic, especially for people in rural environments, especially for people who have things like agoraphobia. They have a hard time leaving their home. Awesome. If I can meet you in your home, let's do it. People who might have other things that limit their access. And sometimes I don't need to see you in person. It's a lot better if we just do things virtually. There are some areas where it's a challenge. Working with kids working with kids with ADHD that's challenge um also teenagers do they have privacy in their room can i really have a session with them where they feel like they can say what they

want to say so there's there's small problems there yeah but no telehealth is great i don't have a problem with that um what i have a problem with are companies that might be um bending ethics and treating people in a really unsustainable way they forgot the pee means patient not profit yeah yeah i think as sad as that sounds yeah all right so to end the conversation when people someone's watching this right now they're overwhelmed they're not sleeping great lots of life stressors perhaps untapped adverse childhood experiences yeah they are interested you've piqued their curiosity you've gotten into the contemplation phase of seeking therapy what's the first step they should do i think the first step is even before seeking therapy and i think that is social support so social support is

seems to be the essential mental health coping skill across all mental health problems and all it means is getting help from other people and the way you want it and it might mean calling up a friend well no one calls anymore DMing someone yeah yeah yeah I feel like a lot of the people I work with they either just text

or like FaceTime or send to audio they do anything but call contacting someone you trust and spending time with them in the way that you want to spend time with them so maybe you're having a hard time and you contact your friend and you just want to play video games together. Awesome. Do that. Or maybe you contact a friend and you want to talk about your problems. Go for it. Do that.

That's what social support means. I think it's really become difficult to do something like that, as simple as it sounds. Getting to a place where you're able to share a little bit more with someone you trust is that first step in getting help. And for a lot of people, that might might be all you need. There's evidence that social support helps sometimes because all you're doing is you're getting your mind off your problems for a bit. And that can be a good thing. Sometimes it helps because you're getting help for it. Sometimes it helps because they're able to help you get more help. So that would be the next step then is if you're at the stage where you're considering treatment is talking to people that you trust about getting help.

So before even seeking help, asking if people's thoughts on you getting help. Yeah. So maybe you talk to someone and they might have a, maybe they've gone through that experience themselves. So for example, if you're in school, talking to a teacher, talking to a counselor, talking to talking to anyone that you trust that might help you to get to that next stage. I'm not talking about people who they found a therapist, they're going there, that kind of, like, no, like, just schedule with that person and go. But if you don't know where to start, talk to someone you trust.

And if you don't know who to talk to, talk to your doctor. That's what I always recommend. You know, because physicians know the system and they can help you get that next step. And if you don't have a doctor you trust and you are in a school environment, talk to you. a counselor if you're in a college environment there is a counseling center in your college that is set up to help you with this um those would be the first steps i would take did i answer your question i didn't even know i answered a question yeah and a good answer um what's the worst hack you've seen when it comes to mental health on like the tictox of the world that you've reacted to

that's a really good question that's a really really really you're like what the hell and it's so perpetuated and you see it over and over again i what's the goop of mental health care oh the goop of mental health care that's a really i get so angry by that stuff that i just like shut it down and put it away i kind of repress all that stuff that is such a good question no one's asking that before. Like, I love the 212 square breathing method. Yeah, yeah. It's like all these things.

Is there what, is there like, when you're like, I wish people would stop saying this one. It's not, it's not helpful. I mean, the astrology stuff really annoys me. Tell me about the astrology stuff. Oh, you know, like, we have these, all the type stuff really annoys me. Type stuff? Yeah, so like, you're Aquarius, I'm an Aquarius.

I only know this because people ask me this question all the time. They're like, what's your sign? And then, so that means you have these set of characteristics, and that means you need to do these different things, and you should be with these kinds of people. That stuff really annoys me, and I really try to be calm, in that, and this gets back to what we were talking before about identity, keep your identity small. That stuff annoys me because I don't want people to be limited by these identities that they impose upon themselves.

Because if you go through your life thinking, yeah, I'm an Aquarius, and so that's why this has happened, this is how psychology works. Like you will find information that fits your worldview and put out the other stuff. It's called motivated reasoning, cognitive dissonance, stuff like that. We find information that fits the way we see the world. And if you, the more of these kind of like, I believe I'm inquirious or I'm an extrovert. I'm an introvert. That's another one that really pisses me off. Yeah, extroversion and introversion exists.

That's a spectrum. Wait, are you saying Aquarius as exists too? The consolation exists. Oh, okay. Yeah, it's definitely out there. But a lot of these, like, I am an introvert, therefore you have all of these characteristics. Like, so you should be doing all of these things. Those TikToks usually really annoying me because they're grossly oversimplifying all of the stuff.

Then people start to internalize that identity. Then they start to believe it. and then it starts to all become true because of this self-fulfilling prophecy. Interversion and extrovision is a spectrum, and it's really about how much does socially being with other people invigorate your battery or, like, drain your battery?

And I'm a really extroverted guy, but a day of therapy makes me want to not see anyone. And so how do you explain that? Am I an introvert? in that situation, am I an extrovert? So again, like identities and types. Like you are this type, you're that type. So you don't like those personality tests either?

No, no, I really don't. Myers-Briggs. Yeah. No, the Myers-Brig stuff is based on junk science. It's not even real science. But it continues. People spend a ton of money on Myers-Briggs tests when there's no science behind it.

Derek, I think it's Derek from Veritasium, has put out a great video about Myersburgs and how it's junk. Vox did another great video on this. There's all these great videos, but then people keep believing, you know, I'm an INFTP, I don't even know the types, right? We never studied this stuff in grad school because it's all junk.

One of the useful science-based personality tests you could take is called the big five personality test it's free it's based on real science go take it you can learn a little bit about yourself but um people end up spending a lot of time a lot of money with a lot of these like i'm going to help you figure out what type you are and then you know solve your problem stuff and a lot of those those things are not those are the things that piss me off that's the answer to the question i'm going to play doctor's devil's advocate is there a world where someone enjoying the field of astrology is

healthy for them. Yeah, so this is why I don't talk, can I swear here? Yeah. This is why I don't talk shit about astrology. I will talk shit about Myers-Briggs. Oh, okay. Because it pretends to be evidence-based. Because it pretends to be evidence base

and that is a problem. I don't talk shit about astrology because it's a big part of a lot of cultures. Yeah. It's a big part of a lot of people's beliefs. And it, you really need to, whenever you're working with someone,

you need to be culturally responsive. I don't really believe in cultural competence. I know a lot of our continuing education pushes the idea of cultural competence. I don't really believe you can ever be competent in someone's life experience and where they come from. But you can't be responsive to it. Or sensitive.

Yeah, or sensitive to integrate it into your work. And you can get really good or better, I should say, at integrating it into your work. And sometimes that means weaving in astrology, how they see the world, the way and the universe, I should probably say, and their beliefs about these things. We have to respect that. We have to understand that. And if we dismiss it, we're never going to be able to make any progress because we're

dismissing a huge part of who they are. You sound like such a Scorpio right now. I don't even know what that means. I have no context for any of this stuff. I have no idea. But the whole time I wanted to say. I feel like I sound like an asshole on a lot of this. You're like such Taurus moon energy with Scorpio Sunrising.

Well, they're in alignment right now, right? The tourists and the Scorpion? I don't know. Those things. Yeah. The stars? Yeah, the stars. Well, if Elon Musk says so.

Yeah. Gosh. The stars are an X. I mean, I worry that I've just like really pissed off and annoyed a lot of people. And maybe that's a good thing because we should have more conversations about this stuff. Be very transparent about what therapy is, how to access it when it works, when it doesn't work, who to seek help for, all the limitations in place. This is a complicated subject. There's no easy answers.

And I'm just hoping that that's one thing people have gained from this country. I hope so too. As someone taking off your clinical psychologist hat, when you're at a dinner with friends and you see someone spewing some astrology, BS about personality types or Myers-Briggs thing, I'm asking this advice for me. How do you handle it? Yeah, that happens a lot. Or if they bring you into the conversation, what do you think? It happens a lot. And especially you're on the West Coast. I am right outside San Francisco. Yeah.

Yeah, yeah, yeah. I mean, one of the things I've had to accept a long time ago is I am becoming an expert in human behavior. And there's no context or situation where human behavior is not relevant. It's relevant to right now, you and I, like matching and mirroring. People have better rapport if they kind of like. sit in similar ways and you know do this kind of like all that like we could talk about all we could talk about behavioralism

here we can we can deconstruct how the whole set is designed and and all in like you there's a little bit of research that if we're 45 degrees from each other will like we'll have better connection than when we're right directly looking this might feel more adversely I could do that

but then I would so annoy you right that is so annoying but you will get so many more views I know, and that's why I don't, Dr. Mike. That's why I'm stuck where I am. The reason I pointed out is because if you look at what stuff does well, and a men's health article just came out about evidence-based mental health and physical health influencers, and they put us on the list, and they only said something negative about us.

They said, we're corny. No. Well, no, no, I actually don't disagree, but I think they're missing the point. Because corny is how I withstand the pressure to corrupt information. Sure, sure. My corny is my shield. Yeah. So in order to make medical information really interesting and viral, you're either selling

miracle potions. Yes. Corrupting the medical information and saying astrology impacts your heart health. Yes. Or you're being corny and self-deprecated. Yes. Yes. Yeah.

So you want to make fun of me for doing that? Yeah. Yeah. I'll take it all day. My dad pun jokes are going to be strong. Oh, we can bring the dad pud jokes. Here's, I go for option four. Okay.

Which is to be really empathic. Okay. And, you know, there's not a lot of views in empathy. Maybe Gary Vee would disagree with me. I mean, that's empathy is the brand over there. And for me, in that dinner conversation, I've learned that I'm going to be that. I will be an asshole if I'm just like correcting people. And so what I do is I try to really understand more about the basis of their belief.

Yeah. I want to understand this is something that's really important to you. How did it become so important? Or like, what does it mean? And I won't ask it in such a therapist kind of way. But I always lean towards all I've got is the relationship. So let's improve the relationship so we can understand each other better. Because only then maybe we can get to a place where they might say, well, you're a psychologist.

Let me ask you about, what do you think about this? And then. And then we can say, I've got a totally different perspective. You know, I've studied this in this way. And here's what I've learned about it. but my life experience is very different you know it wasn't a part of my upbringing you know this and and this is but then i feel like in those situations what ends up happening is we start giving equal weight yeah yeah yeah to both situations there's lines i i won't cross

like if someone is advocating something that i think is really really harmful um this gets to eating disorders self-harm suicidal type of those are really they impact your health your life those are areas where

I am the expert in the room and I'm not going to let you give people advice that might harm them it's a line I don't cross if it's a casual dinner conversation and we're getting to a place

where we're, yeah, given this equal weight, it's not working out. I mean, maybe that relationship is doomed. I'll give you what's in my head so we can play this scenario out for you and you could tell me how you'd react. Yeah. I was at a dinner and I ordered

mushroom cassidias. Okay, sounds good. Tasty. Yeah. And I mean, the Mexican food here is not that great. It's probably... It might have been Mexican. Yeah.

It might have been like a fusion place. Okay. So I tried it and I thought they were lovely and in order to bridge the gap of the person sitting next to me I said, oh, would you like to try one? And her response was that

she doesn't eat mushrooms and I said, oh, why? Do you have an allergy? Yeah. And she goes, well, I don't know if you knew this, mushrooms are a fungus and they give you yeast infections. Oh. Okay. And I didn't know exactly how to react

and I froze for a little bit and I just became very quiet and I probably came off very introspective more than very introverted more than usually I'm at that dinner. Yeah. And then I'm like, what is the right way to react?

Because correcting someone, you're an asshole and you're not going to win, asking why they believe it is giving weight to like where they found this information because it's like clearly not valuable. So I don't, just complete, and it's such a silly scenario to point out.

Yeah. But from that, I can create, you know, a million other scenarios that have happened. But that one I felt like was so honest. Yeah. Of, I have no fucking. I'm just to say right now. And, and then like someone would turn to me back, Mike, you're a doctor. Like, is that true?

And that person didn't know I was a doctor. Like, is that true? Yeah. And I'm just like, hmm. All right. This is tasty. Right, right. I would not, I would, yeah, that's a tough one.

I'm like, this is so good that I would risk a yeast event. I was thinking they were going to go into like the last of us situation and be like, you know, mushrooms might lead to like this world ending like thing. Which would be a mental health situation. Right, right, right. Right. Right. Right. Okay. So was this person someone who is like a casual relationship? Very casual. It's like friend of a friend. Friend of a friend. But I want to become friends closer.

to this person that is really really tricky i think what i would i would do in that situation especially if they're new i would be like oh okay i'm sorry like i don't i wouldn't say sorry for offering you but i would say okay and then continue the conversation elsewhere just move on just move on because like if we're really casual i have no hope of but then what if you're because i was asked yeah is that true and I'm just like, I haven't found that to be true and I kind of just moved on. Yeah, I think I would do something like that

because I don't want to provide disinformation to other people there. I don't want to make people believe that this might be true when it's not and I know it's not. If I don't know if it's true, I would say that, which I think gets back to what we were talking

about intellectual humility. We need to be okay with not knowing. In fact, I think the people who are best at this are my physician friends, like, who might say, like, I don't know, but like, let's find out. Let's do the research. Let's find out. If I'm closer to this person, I might have a deeper conversation about this. And I don't think it's a silly example because this is some of the stuff I deal with.

I struggle with a lot related to so many aspects of mental health and, um, You know, there's like people in my family, there are friends that I know who have become really, um, develop like extreme views on everything from COVID and vaccines to what's really happening in our government and all of that. And the psychological research kind of shows, like we don't have a ton of stuff on this, but it kind of shows the most important thing to do with people who develop these. fringe ideas is to still let them feel like you care about them and you're not ostracizing them or dismissing them because that's probably some of the stuff that might have contributed to them developing these beliefs. There's a lot of pathways into believing misinformation about radicalization. Yeah. There's a lot of ways people get into that. One of the ways is people might be chronically lonely isolated they go down these rabbit holes and it's important to not to it's important

to make sure people feel like you are you still love them you still care about them that your relationship hasn't changed and it's really hard to do that it is deeply well i think it's easier to do in the situation you just described because you you're talking about a person who is isolated lonely and like became self-radicalized. Yeah. I see it more so from decently intellectual people. Yeah. Overstepping their bounds and letting their egos believe that they found something that no one else knows.

Well, everyone really believes they're an expert on these things. Yeah. Everyone believes they're an expert on mental health things and health care things. And this gets to like this gets to like a fundamental. The Dunning Krueger effect, right? So my toilet breaks, it's like, oh, I can fix that, right? How complicated can it be? And then you open it up, you start working on the next thing, like water's leaking everywhere.

When you're tackling things that you don't know much about, you underestimate how complicated they are. And so then you're calling the plumber, and the plumber's like, don't touch this. Yeah, yeah, yeah, yeah, right? We do this all the time when it comes to health care. is we assume that we know a lot more when the stuff is actually a lot more complicated this happened to me at a birthday party

where someone was saying they wanted to share this story from their childhood and then they said oh actually I'm not going to share that story and I was like oh why not and they're like well you know how memory works the more you think about something

the less that memory is going to exist it's going to fade away and I was like, what are you talking about? And they say, yeah, this is like, you know, the more you think about a memory, the more it disappears. And I was like, well, you know, what's definitely true about memories

is when you remember something, you open it up to change. And so if we're talking about a story from your childhood and I give you new information about it, your memory for that might change. But just remembering something doesn't mean the memory is going to

disappear. Some details of it might stick out more, and it might be simplified, and yeah, it might be changed, but it's not just, like, thinking about a memory doesn't make it disappear. And it got into, like, a thing, you know, where they're like, no, I read this article. They plant it. Come on. You didn't see me? Yeah, yeah, yeah. You see? You want me to, like, text it to you? I was like, no, I, I, I, I, I regret saying this. But then I was like, I am a psychologist So much for the intellectual humility, doctor.

I know. I know. I felt so bad, but I was getting so agitated because it was so wrong. And they knew, they knew I am, they knew who I was before. They know what I do. They know what I've studied.

It's weird and it's hard. And it's why I think people will think I'm an asshole after what? I think there's no right answer. No. And I wanted to bring this up earlier. I forgot on one topic and I'm glad you brought this up in my mind. Something that upset me in learning about social media and the ideas of change and people

growing with you and how your followers react to certain controversies and things like that, the fear of being canceled. Do you know Dave Portnoy, the guy who founded a Barstool? No. No. Anyway, he's a little bit of a controversial figure. He says things on purpose as like an agitator. Some things he takes a very straightforward approach on. Sometimes he makes jokes at other people's expenses.

There's been some accusations, what have you. He made a statement that resonated with me and got me worried for humanity. Because while he's usually making jokes, this one I feel holds true and I'm curious your take on it. He said when accusations about him came out, His followers, who were his followers, stanchly followed him, no matter how atrocious the accusations were. Yeah. Then when new information came out to light that he disclosed, that showed those accusations were false. The people who were against him, their minds weren't changed.

Right. So his base, stayed his base, no matter what people said about him or people came out and evidence and testimony. and then the people who were against him, no matter what extenuating circumstances or exculpatory evidence came out, did not care, still hated him. Yeah. And then there was a group of people

who never cared about him to begin with and never watched anyway. Right, right. So he's like, no matter what happened, no matter what I said, no matter what evidence was presented, the group that followed me, followed me, and the people that didn't follow me,

hated me, hated me, hated me, people who never followed, never followed anyway. Yeah, yeah. So it's like, does it matter? Oh my God. Because we worry so much about that, right? The fear of being canceled. Oh, yeah.

And yet, in this extreme example, yeah. Didn't really matter. It didn't really matter. Yeah. I often think about all I have with my audience is my trust. The trust that they have in me, the trust that they have that I am giving honest,

effective sound information. to them. That's all I've got is trust. Trust is the brand, right? And if I lose that, I'm going to lose them. And then there are so many examples like this. J.K. Rowling is another example where I think, yeah, some people have left her, but she's also continuing to get a lot of work and is continuing to be a part of all these scripts and

new Harry Potter projects and all that stuff. She's still profiting heavily off of all the sort of stuff. like does it does it matter um does it i shouldn't say does it matter because that's more of like an unanswerable question sure does it matter does it matter as much as we worry about it you and i any humans because we were all humans worry about being canceled this is like kind of a universal thing yeah whether it's in their workplace that like for a mistake they did yeah being called out let's just say rejected yeah yeah right that's wired in us where one of the great things that we do is where we we can be very

tribal and I mean that in the best case scenario not tribal tribalism is sort of developed this very negative connotation but if you think about tribes it's humans who are not related to each other not completely related to each other working together for a common goal protecting the tribe growing the tribe sharing resources sharing duties all that starts stuff is great. And it's how we scaled up human cooperation so we could do cool things like land on the moon. Like that required massive tribal. Massive tribalism. Yeah. Yeah. In fact, if it wasn't for nations arguing about this and being more tribalistic, it probably wouldn't even happen. We wouldn't have a space race. Yeah, yeah, totally. So when we put our minds to it,

we can do cool things. And also historically, like ancient history wise, if you were thrown out of the tribe why it's so ingrained in us is it was fatal it was fatal but yeah now yeah and so that and it's also again I'm an anxiety guy so the anxiety anxieties change over time and what's more common in childhood is like fear of the death and unknown and witches and dark and stuff like that but when you become a teenager the main fear really becomes rejection and that continues on into a And for this reason that like rejection was death in olden times and we still We still fear it we we want to be liked. We don't want to be rejected. We want to be part of the cool kids We want all that sort of stuff when you're a YouTuber and you're starting out you

You you're always looking up and you're like I want to get this many views just like this person and this many subscribers and all that All that kind of stuff right this is all hard hardwired in us Does it matter now for people like like you and me who develop audiences on these online platforms, maybe not. But for the average person in their life, you bet it matters. You know, going to high school, if something comes out about you and you're ostracize, it doesn't work the same way it works on YouTube or on TikTok or these other kind of things. It can, and if you're young and you're young and you're you're vulnerable, it can really impact your mental health.

It can lead to death. It can lead to suicide, things like that. It absolutely matters for adults if something comes out about you and you lose your job. And now you can't get a recommendation for a new job in those kind of areas. Yeah, I think it matters for most people. It absolutely matters. For media personalities, maybe it doesn't matter. And politicians definitely doesn't matter.

It does not matter for them. But, I mean, that's different. And that's one of the bizarre ways in which the 20th century and 21st century has changed things. We weren't really built to have a following of millions of people. Like, how does that even work? Yeah. Like, our brain can't even comprehend that, you know? Yeah.

I keep saying last question. This is an easy last question. I love the last questions. I've loved all of your last questions. You're like, you are paying my overage fee for this. therapy session. Will we ever have a psychologist as president? Oh man, I'm a big sci-fi guy and one of the cool, I'm a big Treki and one of the cool things and like the most recent versions of Star Trek is we've seen psychologists who are like captains and admirals and stuff and I freaking eat that stuff up. I love it. I think what is more likely is probably, we should play place bets on this and revisit this 30 years from now. I think what's more likely is we're going to see a physician as president first.

Oh, okay. Yeah, yeah. We've seen so many lawyers. That's what I'm saying. Yeah. Yeah. Yeah. And I think what's cool for lawyers, I'm not, again, now the lawyers are going to hate me.

I think what's great, what's amazing about lawyers is they are really trained to believe that they can go down many different paths in life. That you can do consulting. you can do, there's lots of forms of legal practice, you can go public policy, you can become an elected official, all that sort of stuff is up for grabs. Healthcare professionals

are poorly trained to think about other career pathways besides practice or research. That's been my experience. And this is one of the reasons that one of the things that I think you and I both share in common is we

want more people to think outside the box to think outside the box we want more people creating good content we want more people to go into industry and create apps that we just love I would love to celebrate some amazing mental health products I really would so you're your partner with duolingo would make a mental health out yeah yeah in different languages in there yeah yeah you're kind talking about duolingo we were talking about duolingo

and like as how it's a fun way of learning language I've always been fascinated by Pokemon Go okay

are you played it yourself? Oh no so just a cultural phenomenon of it all but it lasted like two days

it all lasted a lot long it's like I think it's the most I'm not I'm not because I remember there was like a time

where People are falling down, like, elevator shafts or something. I think that, like, craze is got, again, craze, maybe that's, yeah, that's true for crazy. Maybe you should have, I needed, I need to talk to you about this word. But I don't think it's as, um, uh, trendy now as it was before. But people are still playing. But people are, I think it's the most popular video game of like all time by like number of users. Sam usually knows that kind of stuff.

Yeah. Yeah. Am I, am I true? Am I, am I accurate? Okay. Well, we'll, we'll fast check this. Sam, Sam, yeah, your audience will let me know. You're gonna back in my eyes. Yeah, yeah. I think by like number of users, it might be,

or a number of players it might be one of the most popular games of all time. Anyways, Pokemon Go. What I think is so cool about Pokemon Go is it's unique to the context you're in where, like the only certain Pokemon you can find in certain places.

I've never played myself. I have zero interest in it. But I've worked with a lot of people who are super passionate about it. So I've always found this idea of like context-aware information to be super interesting for mental health. I mentioned dialectical behavior therapy a few times today, I think.

One of the best parts of DBT is your ability to contact your therapist or another therapist on your therapist's team and get coaching in the moment when you're in a crisis, when you're an emotional crisis. And the way that works is you kind of describe what's going on. Your therapist helps you to apply some of the skills you've been working on in that situation. Therapists are often hesitant to do this type of treatment.

What I've found is it's so helpful in reducing long-term problems because you are teaching the person, helping them in the moment that they need it the most. Not in your office where things are safest, calmest, most stable, but out there in the real world. I hate to relate it to dog training. But like teaching your dog to sit in your house is very difficult than teaching your dogs to sit in a park. And it's just learning in general. Learning often helps, happens best in the context. Exactly.

Where you want that behavior to occur. This is why I'm a behavioralist and you sound like one too. I'm a hybrid. There we go. I'm a Prius. It's always, always, you're a, you're a Prius. I like, I like the new Prius, the one that just came out. But in general, I think they've been butt ugly for so long.

But the new one looks like it's right out of Blade Runner. I love it. It has its grace. Yeah, yeah, that's a, there we go, there we go. So my dream has always been to build the Pokemon Go of mental health apps. So the phone, as you're using it, is able to understand where time and space you are. And there's a social component to it,

where let's say we're in your building right now and entering the elevator, you're having a panic attack. And you're able to open up your phone. The phone knows where you are. And you've learned different skills using this app. But then there's a social component where it says, like, oh, a lot of people here

have had panic attacks going up this elevator. here's what's really helped them and let me guide you through this so a mixture of skill training that's combined with context that intelligently recommends what to do in this situation anyone can go make that I'm not going to make it it's not I am not going to go work in that sounds really good though yeah yeah and difficult do you think most scenarios will have that much overlap location-wise? No. But with enough users, yes.

They will. Yeah. I mean, and that would be the problem for that is how do you scale that out? Two people can have the exact same anxiety problem, and the way to overcome it is completely different. Two people can have panic attacks in the subway, but the context is completely different. What's going to help them is completely different. But if you get a hundred people, now you're going to start to see some overlap.

100 people experience panic on the subway. Now we're going to start to see some patterns. Where you could tailor some questions there. Yes, exactly. Wow. But no one's going to make this app because everything's about it. No, I have faith in humanity. Yeah.

Well, I do too. Mostly. It doesn't sound like it with this app situation. You're like, no one's going to fix it. I have, look, Dr. Mike, I didn't. When I was in grad school in the late 2000s, I never thought we would be in a place where we're having this conversation where publicly in front of this big audience, we can talk about mental health in the way that we have and I can continue going about my career. I never

thought I'd be a place where I could talk about my social anxiety, all the stuff I've gone through and still sort of be okay in public standing. The culture is completely shifted when it comes to talking about mental health. If we are able to continue having these conversations, I do have faith. That we can start solving and tackling some of these big problems.

So I am optimistic about that. What's the biggest advantage in life that you have being that you're a psychologist? The biggest advantage I have? Like as a human. Dr. Mike, these last questions, I know, I just like, he- I'm so freaking good.

Stop asking. Deep last questions. No, but like I'm just curious because like I don't know a lot about psychology. Oh, biggest advantage. Oh, this is obvious. Obvious? This is super clear. This is always the advantage.

I have a ton of friends who are a psychologist. That's the advantage. Oh, that's true. Anytime I'm struggling with someone or I'm struggling. Yeah, anytime I'm struggling with someone or with something myself, I have someone I can text. I have someone. can call. So the worst stuff I've experienced in life, I've talked to with my friends. So access.

Access. I have experts in mental health and psychology. All right. What's the worst thing about being a psychologist? People think I'm always analyzing them and people think that I don't turn it off. And so when people meet me, they're on guard. Really? Oh yeah. Oh yeah. How does a situation like that play out. Oh, so what do you do? Oh, I'm a psychologist. Are you analyzing me right now? Or people like, oh, I need to be careful what I say.

Because they think you're going to do what? I'm going to, I have this knowledge where I'm going to like shrink their head and understand their problems. But isn't that, isn't that, don't we all want to be understood? This gets back to what you were saying earlier about trust and comfort. I think the public understanding of mental health is or of what therapists do is not the best. The reputation is that like we do something to you and it's scary for a lot of people. When the reality is like, I mean, I'm pretty, I've been pretty honest here. This is what you see is what you get.

Like this is who I am. I like to believe that like people will see that in my videos too. although I think my videos come across is more like warm maybe than than what I've been this is more a topic that is very deeply frustrating to me the lack of information and transparency around the mental health system and so it activates me which I think people have seen today but if you meet me in real life I'm exactly how I am and all this stuff I'm not like analyzing you because you can't really do that without a specific effort being put forth Yeah. If you come and sit down and you say, hey, Dr. Ali, these are the problems I'm dealing with. I really want your help here. And then I will be like, okay, so we're doing this. Like, I'm your therapist. Here are the ethical boundaries. Let's dive into it. And that is how that process works. It's a collaboration. But if you sit me down and you say, all right, go to it. What do you think is going on here? I'm going to be like, I don't know, man. This is a weird situation. What are you asking me? This is not how it works.

That's just not the thing. But I'll get people who ask me often, like, hey, my son's struggling with something. And they might describe the situation. And I might ask a couple of questions and then recommend them to see certain people. I might say, like, you should try, call this clinic. They might be a good place to get helpful. it but I can't this is why I can't like diagnose a celebrity unless I sit down and they're my patient oftentimes for many visits yes yes you you make an initial diagnosis because you have to

but it's a preliminary diagnosis and you need time to really understand the problem if someone sits me down as often like they ask like for different TV shows like sit down and like What does this person have? What do you think was going on, right? I don't know because I'm not their therapist. So then why, like we take all these oaths and we have all these ethical principles. Why does so many well-respected psychiatrists, psychologists come out, like even with the elections and politicians and stuff and make claims, like and sign papers and do stuff? You're going to love my answer to this.

You're going to love this. It's because people aren't trained to weave in media into their work. how many classes did you have about talking to journalists yeah but how many times have journalists reached out to you for opinion about something it's a critical skill that every health care professional needs to have is okay you're going to work with a journalist have your talking points ask ask them in advance what is the topic that you'd like to talk to me about you can't ask for their questions because that's journalistic integrity, but you can ask them, like, what's the topic?

Is this something I have competence in? Is this an expertise of mine? If not, I'll refer you to someone else. And then you have your talking points to that. You stick to it, and you never say something that's outside your competence. People don't get trained to do that. So they get scared, they get anxious.

They might say something, then they feel uncomfortable with it. This happened to me in one of my early interviews where I walked away saying, oh man i don't think i should have said that and when you work with uh tv networks you don't have final cut on those videos they they put out what what they put out so it's a skill you got to develop and most experts have not developed that skill but they will be called upon to speak to these issues fair because i see it a lot oh same here and sometimes not because of the lack of

skill sometimes they were willingly volunteering well it's also we want to be liked yeah and we have the belief systems right though as you so described yeah like I'm a person of integrity so I will stand up for what's right and this is the way I have to do it so yeah yeah yeah it's tricky it's a complex world we live in and it moves fast and people don't have patience for long conversations like this one well I'm glad we solved mental health today yeah me too well done sir yeah we're gonna uh what should we take on next world hunger it can't be harder than this problem no

and then world peace after okay well thank you for allowing us to see into that brilliant mind of yours um thanks for having this conversation i remember um i sent out a tweet an ex whatever You know, I exited a while back asking mental health experts to share their mental health advice. And I remember you respond and you're like, I don't know if I'm a mental health person, but here's my advice. And I think what is so awesome about what you do is you keep having these conversations about mental health. You talk about how mental health is health. And I so appreciate that.

so thanks for making this a continued part of what you do absolutely i look to grow it as a collaborative force for good and we will fix it we will fix it if we haven't fixed it today i think we did a lot where do you want people to watch you just go to youtube dot com slash at d r a l i dr ollie is that is that is there's an ad now there's an ad oh i didn't you have an ad i do you he has an ad